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General NPI Number Information
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NPI Number | 1376341230
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Entity Type | Organization
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Legal Business Name | CAMERON DENTAL CENTER
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Dates
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Enumeration Date | 03/06/2025
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 1720 N WALNUT ST
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City | CAMERON
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State | MO
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Zip | 64429-8900
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Country | US
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Telephone | 816-632-6657
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Fax | 816-632-5118
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Provider Business Mailing Address
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Address Line | 1720 N WALNUT ST
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City | CAMERON
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State | MO
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Zip | 64429-8900
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Country | US
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Telephone | 816-632-6657
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Fax | 816-632-5118
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Authorized Official
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Title or Position | DDS
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Name | KYONG-YUN KONG
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Credential |
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Telephone | 816-632-6657
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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 |
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License Number State |
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