Provider Demographics
NPI:1174045603
Name:MAPLES, JEFFREY KYLE (DMD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:KYLE
Last Name:MAPLES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 E MONTCLAIR ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4245
Mailing Address - Country:US
Mailing Address - Phone:417-886-9939
Mailing Address - Fax:
Practice Address - Street 1:1324 E MONTCLAIR ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4245
Practice Address - Country:US
Practice Address - Phone:417-886-9939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170235991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2017023599OtherSTATE LICENSE OF MISSOURI