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General NPI Number Information
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NPI Number | 1306182704
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Entity Type | Organization
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Legal Business Name | NAIL DENTAL LLC
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Dates
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Enumeration Date | 12/13/2012
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Last Update Date | 12/13/2012
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Provider Practice Location Address
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Address Line | 1200 E WOODHURST DR STE M400
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City | SPRINGFIELD
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State | MO
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Zip | 65804-3777
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Country | US
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Telephone | 417-881-1212
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Fax | 417-881-7867
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Provider Business Mailing Address
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Address Line | 1200 E WOODHURST DR STE M400
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City | SPRINGFIELD
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State | MO
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Zip | 65804-3777
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Country | US
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Telephone | 417-881-1212
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Fax | 417-881-7867
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Authorized Official
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Title or Position | SOLE MEMBER/OWNER
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Name | DR. JAMES GARY NAIL
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Credential | D.D.S.
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Telephone | 417-881-1212
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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 | 012092
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2007014543
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License Number State | MO
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