Provider Demographics
NPI:1790079291
Name:ZARON F. KANION/MYERS DENTAL CLINIC DDS, PC
Entity Type:Organization
Organization Name:ZARON F. KANION/MYERS DENTAL CLINIC DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ZARON
Authorized Official - Middle Name:F
Authorized Official - Last Name:KANION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-921-8187
Mailing Address - Street 1:5240 PROSPECT
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64130
Mailing Address - Country:US
Mailing Address - Phone:816-921-8187
Mailing Address - Fax:816-921-2086
Practice Address - Street 1:5240 PROSPECT
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64130
Practice Address - Country:US
Practice Address - Phone:816-921-8187
Practice Address - Fax:816-921-2086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO142181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO402058101Medicaid