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General NPI Number Information
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NPI Number | 1124266812
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Entity Type | Organization
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Legal Business Name | JON C. MANN, D.M.D., LLC
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Dates
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Enumeration Date | 02/03/2009
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Last Update Date | 02/03/2009
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Provider Practice Location Address
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Address Line | 206 S 2ND AVE
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City | OZARK
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State | MO
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Zip | 65721-8467
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Country | US
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Telephone | 417-581-2430
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Fax | 417-581-5235
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Provider Business Mailing Address
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Address Line | PO BOX 1610
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City | OZARK
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State | MO
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Zip | 65721-1610
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Country | US
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Telephone | 417-581-2430
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Fax | 417-581-5235
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Authorized Official
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Title or Position | PRESIDENT
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Name | JON C MANN
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Credential | D.M.D.
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Telephone | 417-581-2430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 16094
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License Number State | MO
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