=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093650947
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SFFD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2026
-----------------------------------------------------
Last Update Date | 04/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 636 W REPUBLIC RD STE 120
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65807-5803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-882-3200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 636 W REPUBLIC RD STE 120
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65807-5803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NATHAN BOWEN
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 702-283-8421
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------