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General NPI Number Information
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NPI Number | 1861876005
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Entity Type | Individual
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Provider Name | JUDITH NZEMBI TONLAAR D.D.S
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Gender | Female
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Dates
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Enumeration Date | 07/17/2015
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Last Update Date | 03/22/2017
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Provider Practice Location Address
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Address Line | 2241 N GLENSTONE AVE
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City | SPRINGFIELD
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State | MO
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Zip | 65803-4647
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Country | US
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Telephone | 417-862-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 4721 S STEWART AVE
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City | SPRINGFIELD
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State | MO
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Zip | 65804-7567
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Country | US
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Telephone | 616-516-8582
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2901021657
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License Number State | MI
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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 | 2016017018
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License Number State | MO
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