Provider Demographics
NPI:1477992246
Name:KANNING, NELSON CARTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:CARTER
Last Name:KANNING
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 1:201 EAST 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:LAWSON
Mailing Address - State:MO
Mailing Address - Zip Code:64062
Mailing Address - Country:US
Mailing Address - Phone:816-580-4191
Mailing Address - Fax:816-296-3058
Practice Address - Street 1:201 E 6TH ST
Practice Address - Street 2:
Practice Address - City:LAWSON
Practice Address - State:MO
Practice Address - Zip Code:64062-7804
Practice Address - Country:US
Practice Address - Phone:816-580-4191
Practice Address - Fax:816-296-3058
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MO2013016719122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies