Provider Demographics
NPI:1649302019
Name:WILLIAM T. KANE, DDS,MBA,PL
Entity type:Organization
Organization Name:WILLIAM T. KANE, DDS,MBA,PL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MBA
Authorized Official - Phone:573-624-7456
Mailing Address - Street 1:POST OFFICE BOX 246
Mailing Address - Street 2:913 WEST BUSINESS HIGHWAY 60
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841
Mailing Address - Country:US
Mailing Address - Phone:573-624-7456
Mailing Address - Fax:573-624-5182
Practice Address - Street 1:913 WEST BUSINESS HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841
Practice Address - Country:US
Practice Address - Phone:573-624-7456
Practice Address - Fax:573-624-5182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO13323122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty