Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 015779 | MO |
NPI | 1104237809 |
---|---|
Provider Name | Dr. Simon Macneill |
First Address | Kansas City, MO 64108-2716 |
Second Address | Kansas City, MO 64108-2716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2014 |
Last Update Date | 15/05/2014 |