Provider Demographics
NPI:1225144470
Name:STIVER, GREGORY A (DDD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:STIVER
Suffix:
Gender:M
Credentials:DDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 EAST 135TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64145
Mailing Address - Country:US
Mailing Address - Phone:816-941-7788
Mailing Address - Fax:816-941-4413
Practice Address - Street 1:325 EAST 135TH ST.
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64145
Practice Address - Country:US
Practice Address - Phone:816-941-7788
Practice Address - Fax:816-941-4413
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO141291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO14129OtherLISENSE NUMBER