Provider Demographics
NPI:1558462226
Name:MCNAMARA, KEVIN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:MCNAMARA
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 1:103 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-2480
Mailing Address - Country:US
Mailing Address - Phone:816-331-9100
Mailing Address - Fax:816-331-9133
Practice Address - Street 1:103 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-2480
Practice Address - Country:US
Practice Address - Phone:816-331-9100
Practice Address - Fax:816-331-9133
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO150121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice