Healthcare Provider Details

I. General information

NPI: 1861876005
Provider Name (Legal Business Name): JUDITH NZEMBI TONLAAR D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2241 N GLENSTONE AVE
SPRINGFIELD MO
65803-4647
US

IV. Provider business mailing address

4721 S STEWART AVE
SPRINGFIELD MO
65804-7567
US

V. Phone/Fax

Practice location:
  • Phone: 417-862-8300
  • Fax:
Mailing address:
  • Phone: 616-516-8582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901021657
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2016017018
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: