Healthcare Provider Details

I. General information

NPI: 1649368564
Provider Name (Legal Business Name): PRIGGEL FAMILY DENTISTRY DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 TANNER ST PRIGGEL FAMILY DENTISTRY DMD LLC
SIKESTON MO
63801
US

IV. Provider business mailing address

504 TANNER ST PRIGGEL FAMILY DENTISTRY DMD LLC
SIKESTON MO
63801
US

V. Phone/Fax

Practice location:
  • Phone: 573-472-3032
  • Fax: 573-472-3382
Mailing address:
  • Phone: 573-472-3032
  • Fax: 573-472-3382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MARK HERMAN PRIGGEL
Title or Position: DENTIST
Credential: DMD
Phone: 573-472-3032