Healthcare Provider Details

I. General information

NPI: 1811641749
Provider Name (Legal Business Name): ASCEND BRANSON WEST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 02/09/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18020 BUSINESS 13 SUITE E
BRANSON WEST MO
65737
US

IV. Provider business mailing address

PO BOX 2045
BRANSON WEST MO
65737
US

V. Phone/Fax

Practice location:
  • Phone: 417-272-3352
  • Fax: 417-272-1518
Mailing address:
  • Phone: 417-272-3352
  • Fax: 417-272-1518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. DEREK MAGERS
Title or Position: DENTIST/CO-OWNER
Credential: D.D.S.
Phone: 417-887-3100