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General NPI Number Information
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NPI Number | 1194455691
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Entity Type | Organization
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Legal Business Name | SHOUMAN AND TEGERDINE DENTISTRY LLC
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Dates
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Enumeration Date | 06/16/2022
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Last Update Date | 06/16/2022
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Provider Practice Location Address
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Address Line | 2216 FORUM BLVD STE 104
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City | COLUMBIA
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State | MO
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Zip | 65203-5409
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Country | US
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Telephone | 573-449-0096
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Fax | 573-449-0099
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Provider Business Mailing Address
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Address Line | 2216 FORUM BLVD STE 104
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City | COLUMBIA
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State | MO
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Zip | 65203-5409
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Country | US
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Telephone | 573-449-0096
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Fax | 573-449-0099
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Authorized Official
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Title or Position | MEMBER
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Name | DR. RAMSEY O SHOUMAN
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Credential | DDS
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Telephone | 573-449-0096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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