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General NPI Number Information
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NPI Number | 1467693630
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Entity Type | Organization
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Legal Business Name | SCHAFFER AND DITTO DDS, PC
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Dates
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Enumeration Date | 03/17/2009
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Last Update Date | 03/17/2009
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Provider Practice Location Address
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Address Line | 2602 CUNNINGHAM AVE
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City | JOPLIN
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State | MO
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Zip | 64804-1542
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Country | US
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Telephone | 417-623-2000
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Fax | 417-623-7948
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Provider Business Mailing Address
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Address Line | 2602 CUNNINGHAM AVE
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City | JOPLIN
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State | MO
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Zip | 64804-1542
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Country | US
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Telephone | 417-623-2000
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Fax | 417-623-7948
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Authorized Official
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Title or Position | INSURANCE COORDINATOR
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Name | SHANA HOLMAN
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Credential |
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Telephone | 417-623-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 11810
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License Number State | MO
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