MEDICARE: DR. MISTY M DEATON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2007014531	MO

General Provider Information

NPI Number	:	1942409008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MISTY M DEATON D.D.S.

Provider Business Mailing Address
First Line	:	1001 W HILL ST
Second Line	:
City	:	NEOSHO
State	:	MO
Zip	:	64850-1642
Country	:	US
Telephone Number	:	417-451-6600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 W HILL ST
Second Line	:
City	:	NEOSHO
State	:	MO
Zip	:	64850-1642
Country	:	US
Telephone Number	:	417-451-6600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	07/17/2007

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