MEDICARE: ITOOTH FAMILY DENTISTRY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1275094864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ITOOTH FAMILY DENTISTRY, LLC

Provider Business Mailing Address
First Line	:	3211 E BATTLEFIELD ST STE 100
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-4071
Country	:	US
Telephone Number	:	417-883-8515
Fax Number	:	888-975-3724

Provider Business Practice Location Address
First Line	:	3211 E BATTLEFIELD ST STE 100
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-4071
Country	:	US
Telephone Number	:	417-883-8515
Fax Number	:	888-975-3724

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. LANCE SPENCER ROBBINS
Credential	:	DDS
Telephone Number	:	417-883-8515

Provider Enumeration Date	:	03/27/2019
Last Update Date	:	03/27/2019

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