Provider Demographics
NPI:1851347843
Name:KIVETT, GREGORY BRUCE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:BRUCE
Last Name:KIVETT
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7301 W HWY 86
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-8608
Mailing Address - Country:US
Mailing Address - Phone:417-781-5600
Mailing Address - Fax:417-623-5177
Practice Address - Street 1:525 W 32ND ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2514
Practice Address - Country:US
Practice Address - Phone:417-781-5600
Practice Address - Fax:417-623-5177
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050150221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice