Provider Demographics
NPI:1407127004
Name:JAMES L. MCCREARY DDS
Entity Type:Organization
Organization Name:JAMES L. MCCREARY DDS
Other - Org Name:CITADEL DENTAL GROUP KC MO
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST-OWNER OF PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LARRY
Authorized Official - Last Name:MCCREARY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-523-4444
Mailing Address - Street 1:1734 E 63RD STREET
Mailing Address - Street 2:SUITE #401
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110
Mailing Address - Country:US
Mailing Address - Phone:816-523-4444
Mailing Address - Fax:816-523-2689
Practice Address - Street 1:1734 E 63RD STREET
Practice Address - Street 2:SUITE #401
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110
Practice Address - Country:US
Practice Address - Phone:816-523-4444
Practice Address - Fax:816-523-2689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO11801126800000X
MO2006023201126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes126800000XDental ProvidersDental AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000548Medicaid