Healthcare Provider Details

I. General information

NPI: 1083836381
Provider Name (Legal Business Name): THE TOOTH TRUCK INC. DBA RONALD MCDONALD CARE MOBILE OF THE OZARKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 E. PRIMROSE
SPRINGFIELD MO
65807
US

IV. Provider business mailing address

949 E. PRIMROSE
SPRINGFIELD MO
65807
US

V. Phone/Fax

Practice location:
  • Phone: 417-875-3504
  • Fax:
Mailing address:
  • Phone: 417-875-3504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number StateMO

VIII. Authorized Official

Name: BONNIE KELLER
Title or Position: PRESIDENT CEO
Credential:
Phone: 417-875-3503