Provider Demographics
NPI:1447765029
Name:DENTAL 32, L.L.C.
Entity Type:Organization
Organization Name:DENTAL 32, L.L.C.
Other - Org Name:DENTAL 32
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-881-3200
Mailing Address - Street 1:2142 S BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2539
Mailing Address - Country:US
Mailing Address - Phone:417-881-3200
Mailing Address - Fax:
Practice Address - Street 1:2142 S BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2539
Practice Address - Country:US
Practice Address - Phone:417-881-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014016823261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1689710873Medicaid