Provider Demographics
NPI:1679659536
Name:L G KANNING DDS PC
Entity Type:Organization
Organization Name:L G KANNING DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:KANNING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-296-3252
Mailing Address - Street 1:201 EAST D HWY
Mailing Address - Street 2:P.O.BOX 496
Mailing Address - City:LAWSON
Mailing Address - State:MO
Mailing Address - Zip Code:64062-4826
Mailing Address - Country:US
Mailing Address - Phone:816-296-3252
Mailing Address - Fax:
Practice Address - Street 1:201 EAST 6TH STR
Practice Address - Street 2:
Practice Address - City:LAWSON
Practice Address - State:MO
Practice Address - Zip Code:64062-4826
Practice Address - Country:US
Practice Address - Phone:816-296-3252
Practice Address - Fax:816-296-3058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO011458261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental