Provider Demographics
NPI:1518937192
Name:TAKACS, GYULA (DDS)
Entity Type:Individual
Prefix:DR
First Name:GYULA
Middle Name:
Last Name:TAKACS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-4110
Mailing Address - Country:US
Mailing Address - Phone:417-991-3400
Mailing Address - Fax:417-991-3101
Practice Address - Street 1:833 HOWARD DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-4110
Practice Address - Country:US
Practice Address - Phone:417-991-3400
Practice Address - Fax:417-991-3101
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070250371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2007025037OtherSTATE LICENSE