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General NPI Number Information
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NPI Number | 1225450075
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Entity Type | Organization
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Legal Business Name | GREGORY B KIVETT JR LLC
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Dates
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Enumeration Date | 01/14/2014
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Last Update Date | 01/14/2014
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Provider Practice Location Address
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Address Line | 525 W 32ND ST
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City | JOPLIN
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State | MO
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Zip | 64804-2514
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Country | US
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Telephone | 417-781-5600
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Fax | 417-623-5177
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Provider Business Mailing Address
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Address Line | 525 W 32ND ST
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City | JOPLIN
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State | MO
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Zip | 64804-2514
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Country | US
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Telephone | 417-781-5600
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Fax | 417-623-5177
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MEGAN KIVETT
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Credential |
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Telephone | 417-781-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2005015022
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License Number State | MO
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