Provider Demographics
NPI:1598963191
Name:MACE, DUSTIN K (DDS)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:K
Last Name:MACE
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 1:801 W 47TH ST
Mailing Address - Street 2:SUITE 408
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-1377
Mailing Address - Country:US
Mailing Address - Phone:816-561-6150
Mailing Address - Fax:
Practice Address - Street 1:801 W 47TH ST
Practice Address - Street 2:SUITE 408
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1377
Practice Address - Country:US
Practice Address - Phone:816-561-6150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007014538122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist