Provider Demographics
NPI:1679639751
Name:CUMMINGS, KEVIN J (DENTIST)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W 113TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-5259
Mailing Address - Country:US
Mailing Address - Phone:816-943-0760
Mailing Address - Fax:
Practice Address - Street 1:401 SW WARD RD
Practice Address - Street 2:SUITE 204
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-2448
Practice Address - Country:US
Practice Address - Phone:816-246-1003
Practice Address - Fax:816-246-9808
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO137281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice