=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356788541
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW SCOTT KUEKER D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2013
-----------------------------------------------------
Last Update Date | 05/28/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 135 W 11TH ST
-----------------------------------------------------
City | CONCORDIA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66901-4207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-243-2212
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 135 W 11TH ST
-----------------------------------------------------
City | CONCORDIA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66901-4207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-243-2212
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 60966
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------