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General NPI Number Information
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NPI Number | 1003919606
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Entity Type | Organization
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Legal Business Name | ADVANCED DENTAL CARE OF FORT SCOTT INC.
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1115 S MAIN ST
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City | FORT SCOTT
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State | KS
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Zip | 66701-2651
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Country | US
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Telephone | 620-223-4448
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Fax |
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Provider Business Mailing Address
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Address Line | 2827 ARIZONA AVE
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City | JOPLIN
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State | MO
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Zip | 64804-3102
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Country | US
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Telephone | 417-782-5005
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Fax | 417-782-0175
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Authorized Official
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Title or Position | OWNER
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Name | JOHN C. DURLING
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Credential | DDS
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Telephone | 417-782-4295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | MO
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