Healthcare Provider Details

I. General information

NPI: 1447765029
Provider Name (Legal Business Name): DENTAL 32, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 12/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 S BRENTWOOD BLVD
SPRINGFIELD MO
65804-2539
US

IV. Provider business mailing address

2142 S BRENTWOOD BLVD
SPRINGFIELD MO
65804-2539
US

V. Phone/Fax

Practice location:
  • Phone: 417-881-3200
  • Fax:
Mailing address:
  • Phone: 417-881-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number2014016823
License Number StateMO

VIII. Authorized Official

Name: DR. ASHLEY DAWN MEYER
Title or Position: DENTIST
Credential: D.D.S.
Phone: 417-881-3200