Provider Demographics
NPI:1457192957
Name:MCGUIRE, KELLY (DDS)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 RUSSELL BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-1712
Mailing Address - Country:US
Mailing Address - Phone:573-777-0700
Mailing Address - Fax:
Practice Address - Street 1:707 MINNESOTA AVE STE 100
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66101-2721
Practice Address - Country:US
Practice Address - Phone:913-321-4385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS621531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice