Healthcare Provider Details

I. General information

NPI: 1780796870
Provider Name (Legal Business Name): FRANKLIN COUNTY FAMILY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 ELM ST
WASHINGTON MO
63090-2310
US

IV. Provider business mailing address

416 ELM ST
WASHINGTON MO
63090-2310
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-2804
  • Fax: 636-239-9660
Mailing address:
  • Phone: 636-239-2804
  • Fax: 636-239-9660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOSEPH M LAVENTURE
Title or Position: OWNER
Credential: DMD
Phone: 636-239-2804