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General NPI Number Information
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NPI Number | 1407967003
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Entity Type | Organization
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Legal Business Name | BRUCE E RINGDAHL LLC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 201 W BROADWAY
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City | COLUMBIA
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State | MO
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Zip | 65203-3842
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Country | US
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Telephone | 573-443-1618
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Fax |
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Provider Business Mailing Address
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Address Line | 201 W BROADWAY
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City | COLUMBIA
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State | MO
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Zip | 65203-3842
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRUCE RINGDAHL
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Credential |
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Telephone | 573-443-1618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 015061
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License Number State | MO
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