Provider Demographics
NPI:1780970327
Name:DEAKINS, JOHN A (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:DEAKINS
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 1:6416 N COSBY AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2377
Mailing Address - Country:US
Mailing Address - Phone:573-823-3612
Mailing Address - Fax:
Practice Address - Street 1:6 VICTORY LN STE 1
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3805
Practice Address - Country:US
Practice Address - Phone:816-781-7280
Practice Address - Fax:816-781-7568
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011018553122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist