Provider Demographics
NPI:1386819605
Name:DENTAL CARE OF NIXA
Entity Type:Organization
Organization Name:DENTAL CARE OF NIXA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOFRON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-725-9108
Mailing Address - Street 1:600 MCCROSKEY ST
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-9408
Mailing Address - Country:US
Mailing Address - Phone:417-725-3108
Mailing Address - Fax:417-725-2918
Practice Address - Street 1:600 MCCROSKEY ST
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-9408
Practice Address - Country:US
Practice Address - Phone:417-725-3108
Practice Address - Fax:417-725-2918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty