Healthcare Provider Details

I. General information

NPI: 1801091657
Provider Name (Legal Business Name): GIPSON, ARQUITT, MEYER AND SHANER DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 E MONTCLAIR ST SUITE 100
SPRINGFIELD MO
65807-5076
US

IV. Provider business mailing address

1103 E MONTCLAIR ST SUITE 100
SPRINGFIELD MO
65807-5076
US

V. Phone/Fax

Practice location:
  • Phone: 417-887-8800
  • Fax: 417-887-6265
Mailing address:
  • Phone: 417-887-8800
  • Fax: 417-887-6265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateMO

VIII. Authorized Official

Name: MS. SUSAN RUST
Title or Position: ADMINISTRATOR
Credential:
Phone: 417-887-8800