Provider Demographics
NPI:1124689112
Name:EZELL, KAI MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:KAI
Middle Name:MICHAEL
Last Name:EZELL
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 1:2980 GILLHAM RD APT 410
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-3162
Mailing Address - Country:US
Mailing Address - Phone:620-200-2122
Mailing Address - Fax:
Practice Address - Street 1:6340 N CHATHAM AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-2473
Practice Address - Country:US
Practice Address - Phone:816-746-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190219541223G0001X
KS619341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice