Provider Demographics
NPI:1417118092
Name:POWELL, DON LEE (DDS)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:LEE
Last Name:POWELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 E WOODHURST DR
Mailing Address - Street 2:M100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4260
Mailing Address - Country:US
Mailing Address - Phone:417-881-4300
Mailing Address - Fax:417-881-0776
Practice Address - Street 1:1200 E WOODHURST DR
Practice Address - Street 2:M100
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4260
Practice Address - Country:US
Practice Address - Phone:417-881-4300
Practice Address - Fax:417-881-0776
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO0126031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics