Provider Demographics
NPI:1164597407
Name:KAVANAUGH, KURT EDWARD (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:EDWARD
Last Name:KAVANAUGH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8407 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2426
Mailing Address - Country:US
Mailing Address - Phone:816-420-8100
Mailing Address - Fax:816-420-8416
Practice Address - Street 1:8407 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2426
Practice Address - Country:US
Practice Address - Phone:816-420-8100
Practice Address - Fax:816-420-8416
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0145471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics