Provider Demographics
NPI:1235636531
Name:DUFF FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:DUFF FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:CARISA
Authorized Official - Last Name:DUFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-501-8601
Mailing Address - Street 1:1251 E SUNSHINE ST STE 108
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1162
Mailing Address - Country:US
Mailing Address - Phone:417-501-8601
Mailing Address - Fax:417-501-8602
Practice Address - Street 1:1251 E SUNSHINE ST STE 108
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1162
Practice Address - Country:US
Practice Address - Phone:417-501-8601
Practice Address - Fax:417-501-8602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty