Healthcare Provider Details

I. General information

NPI: 1891859195
Provider Name (Legal Business Name): JOHN T HUKE III D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 NW LAKECREST LN
PARKVILLE MO
64152-3152
US

IV. Provider business mailing address

8720 NW BAKER ROAD CIRCLE
PARKVILLE MO
64153
US

V. Phone/Fax

Practice location:
  • Phone: 816-741-4611
  • Fax: 816-741-6016
Mailing address:
  • Phone: 816-880-0222
  • Fax: 816-741-4611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number015173
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: