Provider Demographics
NPI:1659416345
Name:PIERCE, KEVIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:PIERCE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SPUR DRIVE
Mailing Address - Street 2:SUITE 30
Mailing Address - City:MARSHFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65706
Mailing Address - Country:US
Mailing Address - Phone:417-859-3800
Mailing Address - Fax:417-468-2238
Practice Address - Street 1:1100 SPUR DR
Practice Address - Street 2:SUITE 30
Practice Address - City:MARSHFIELD
Practice Address - State:MO
Practice Address - Zip Code:65706-2348
Practice Address - Country:US
Practice Address - Phone:417-859-3800
Practice Address - Fax:417-468-2238
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO015854122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist