Provider Demographics
NPI:1679798144
Name:MCCARVILLE, KIRSTIN TY (DDS)
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:TY
Last Name:MCCARVILLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4784 OAK ST APT 324
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-2223
Mailing Address - Country:US
Mailing Address - Phone:402-203-3593
Mailing Address - Fax:816-235-2166
Practice Address - Street 1:650 E 25TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2784
Practice Address - Country:US
Practice Address - Phone:816-235-2160
Practice Address - Fax:816-235-2166
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060130831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice