Provider Demographics
NPI:1831401801
Name:KANE, WILLIAM T (DDS, MBA)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:T
Last Name:KANE
Suffix:
Gender:M
Credentials:DDS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-0246
Mailing Address - Country:US
Mailing Address - Phone:573-624-7456
Mailing Address - Fax:573-624-5182
Practice Address - Street 1:913 W BUS HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-2704
Practice Address - Country:US
Practice Address - Phone:573-624-7456
Practice Address - Fax:573-624-5182
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO133231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO13323OtherSTATE LICENSE