Healthcare Provider Details

I. General information

NPI: 1952108623
Provider Name (Legal Business Name): MATTHEW CLIFFORD LEAVITT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5240 N TOWNE CENTRE DR STE 201
OZARK MO
65721-9075
US

IV. Provider business mailing address

5154 S CLOVERDALE LN
BATTLEFIELD MO
65619-9688
US

V. Phone/Fax

Practice location:
  • Phone: 417-581-0000
  • Fax:
Mailing address:
  • Phone: 208-702-3026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2025023423
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: