Healthcare Provider Details

I. General information

NPI: 1902581283
Provider Name (Legal Business Name): KMAPLES ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 06/15/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 ROCKHILL DRIVE SUITE 4
FORSYTH MO
65653
US

IV. Provider business mailing address

PO BOX 1239
FORSYTH MO
65653-1239
US

V. Phone/Fax

Practice location:
  • Phone: 417-251-9179
  • Fax:
Mailing address:
  • Phone: 417-251-9179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY KYLE MAPLES
Title or Position: DOCTOR OF MEDICAL DENTISTRY
Credential: DMD
Phone: 417-496-0547