MEDICARE: DR. TUCKER J VANYPEREN D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2013015430	MO

General Provider Information

NPI Number	:	1710324645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TUCKER J VANYPEREN D.M.D.

Provider Business Mailing Address
First Line	:	8664 NE 97TH TER
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64157-7618
Country	:	US
Telephone Number	:	801-472-3596
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 SWIFT AVE
Second Line	:
City	:	NORTH KANSAS CITY
State	:	MO
Zip	:	64116-3424
Country	:	US
Telephone Number	:	816-471-2911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2013
Last Update Date	:	06/01/2013

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