Provider Demographics
NPI:1073928495
Name:KC CONE BEAM, L.L.C.
Entity Type:Organization
Organization Name:KC CONE BEAM, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-599-2228
Mailing Address - Street 1:11900 W 87TH STREET PKWY
Mailing Address - Street 2:SUITE 128
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2807
Mailing Address - Country:US
Mailing Address - Phone:913-599-2228
Mailing Address - Fax:913-599-2229
Practice Address - Street 1:11900 W 87TH STREET PKWY
Practice Address - Street 2:SUITE 128
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-2807
Practice Address - Country:US
Practice Address - Phone:913-599-2228
Practice Address - Fax:913-599-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSBL13-001551223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSBL13-00155OtherLICENSE