Provider Demographics
NPI:1639167885
Name:KANNING, LARRY G (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:G
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 1:20470 N RAUM RD
Mailing Address - Street 2:
Mailing Address - City:LAWSON
Mailing Address - State:MO
Mailing Address - Zip Code:64062-8305
Mailing Address - Country:US
Mailing Address - Phone:816-580-3345
Mailing Address - Fax:
Practice Address - Street 1:201 EAST 6TH ST
Practice Address - Street 2:BOX 496
Practice Address - City:LAWSON
Practice Address - State:MO
Practice Address - Zip Code:64062
Practice Address - Country:US
Practice Address - Phone:816-296-3252
Practice Address - Fax:816-296-3058
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0114581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice