Healthcare Provider Details

I. General information

NPI: 1093650947
Provider Name (Legal Business Name): SFFD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 W REPUBLIC RD STE 120
SPRINGFIELD MO
65807-5803
US

IV. Provider business mailing address

636 W REPUBLIC RD STE 120
SPRINGFIELD MO
65807-5803
US

V. Phone/Fax

Practice location:
  • Phone: 417-882-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NATHAN BOWEN
Title or Position: OWNER
Credential: DMD
Phone: 702-283-8421