Healthcare Provider Details

I. General information

NPI: 1225057029
Provider Name (Legal Business Name): JOHN RANCE DAVIS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4016 MAIN ST
CASSVILLE MO
65625-9753
US

IV. Provider business mailing address

4016 MAIN ST
CASSVILLE MO
65625-9753
US

V. Phone/Fax

Practice location:
  • Phone: 417-847-0057
  • Fax:
Mailing address:
  • Phone: 417-847-0057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19572
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number2020022988
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: