Healthcare Provider Details

I. General information

NPI: 1164360368
Provider Name (Legal Business Name): AARON EMMETT MILLERSCHULTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 E 20TH ST
JOPLIN MO
64804-2204
US

IV. Provider business mailing address

5711 S 60TH PL
ROGERS AR
72758-8008
US

V. Phone/Fax

Practice location:
  • Phone: 417-623-2440
  • Fax:
Mailing address:
  • Phone: 479-278-1005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2026023429
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: