Healthcare Provider Details

I. General information

NPI: 1891760880
Provider Name (Legal Business Name): MICKEY LEE UNSELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 NE WINDSOR DR
LEES SUMMIT MO
64086-5594
US

IV. Provider business mailing address

1218 NE WINDSOR DR
LEES SUMMIT MO
64086-5594
US

V. Phone/Fax

Practice location:
  • Phone: 816-554-7668
  • Fax: 816-554-7651
Mailing address:
  • Phone: 816-554-7668
  • Fax: 816-554-7651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number015067
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: