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NPI Code Detail

MEDICARE: MATTINGLY BOXDORFER DENTAL

MEDICARE: MATTINGLY BOXDORFER DENTAL
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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1679206056
Entity Type Code : Organization
Provider Name (Legal Business Name) : MATTINGLY BOXDORFER DENTAL
Provider Business Mailing Address
First Line : 22 S WEST ST
Second Line :
City : PERRYVILLE
State : MO
Zip : 63775-2547
Country : US
Telephone Number : 573-547-6691
Fax Number : 573-547-6696
Provider Business Practice Location Address
First Line : 22 S WEST ST
Second Line :
City : PERRYVILLE
State : MO
Zip : 63775-2547
Country : US
Telephone Number : 573-547-6691
Fax Number : 573-547-6696
Authorized Official
Title or Position : DENTIST/OWNER
Name : DR. KEVIN M MATTINGLY
Credential : DDS
Telephone Number : 573-547-6691
Provider Enumeration Date : 07/05/2022
Last Update Date : 07/05/2022

Similar Medicare Providers

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Practice Location Address:
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1679202865 — KATHERINE BOXDORFER DDS
Practice Location Address:
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63775-2547
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1194457044 — MATTINGLY BOXDORFER DENTAL
Practice Location Address:
22 S WEST ST
PERRYVILLE, MO
63775-2547
Practice Phone: 573-547-6691
Practice Fax: 573-547-6696

Directions to “MATTINGLY BOXDORFER DENTAL ” Practice Location

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