Healthcare Provider Details

I. General information

NPI: 1912026741
Provider Name (Legal Business Name): TERESA LYNN CARTWRIGHT DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 SPRUCE AVE
CABOOL MO
65689
US

IV. Provider business mailing address

PO BOX 829
CABOOL MO
65689-0829
US

V. Phone/Fax

Practice location:
  • Phone: 417-962-3150
  • Fax: 417-962-5839
Mailing address:
  • Phone: 417-962-3150
  • Fax: 417-962-5839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number014462
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: