Provider Demographics
NPI:1942354998
Name:KANION, SHAUN LYDELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:LYDELL
Last Name:KANION
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:4701 CANAAN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-3840
Mailing Address - Country:US
Mailing Address - Phone:785-239-7241
Mailing Address - Fax:785-239-7245
Practice Address - Street 1:520 POPE AVENUE
Practice Address - Street 2:US ARMY DENTAL ACTIVITY
Practice Address - City:FT. LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66027
Practice Address - Country:US
Practice Address - Phone:785-239-7241
Practice Address - Fax:785-239-7245
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00185451223G0001X
MO20050156711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice