Provider Demographics
NPI:1952505679
Name:CUMMINGS, MATTHEW JOEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JOEL
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S. WARD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LEE'S SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081
Mailing Address - Country:US
Mailing Address - Phone:816-246-1003
Mailing Address - Fax:816-246-9808
Practice Address - Street 1:401 S. WARD
Practice Address - Street 2:SUITE 204
Practice Address - City:LEE'S SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081
Practice Address - Country:US
Practice Address - Phone:816-246-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007014608122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist