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General NPI Number Information
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NPI Number | 1609649524
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Entity Type | Organization
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Legal Business Name | TW PRACTICE PARTNERS MISSOURI PC
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Dates
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Enumeration Date | 11/02/2023
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 1701 E 10TH ST
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City | ROLLA
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State | MO
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Zip | 65401-4601
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Country | US
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Telephone | 573-364-1599
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Fax |
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Provider Business Mailing Address
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Address Line | 10 BURTON HILLS BLVD STE 400
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City | NASHVILLE
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State | TN
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Zip | 37215-3004
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Country | US
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Telephone | 615-479-2196
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RYAN MCCOSTLIN
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Credential |
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Telephone | 615-479-2196
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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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