Provider Demographics
NPI:1447794193
Name:TEAM DENTAL INC
Entity Type:Organization
Organization Name:TEAM DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMUS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:417-626-8326
Mailing Address - Street 1:2710 S PITCHER AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1643
Mailing Address - Country:US
Mailing Address - Phone:417-626-8326
Mailing Address - Fax:417-553-7896
Practice Address - Street 1:2710 S PITCHER AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1643
Practice Address - Country:US
Practice Address - Phone:417-626-8326
Practice Address - Fax:417-553-7896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140188411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty