Provider Demographics
NPI:1760866255
Name:BPD SOUTH LLC
Entity Type:Organization
Organization Name:BPD SOUTH LLC
Other - Org Name:BEN PYATT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:PYATT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-732-2823
Mailing Address - Street 1:258 US HIGHWAY 60 E
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-1938
Mailing Address - Country:US
Mailing Address - Phone:417-732-7090
Mailing Address - Fax:417-732-4442
Practice Address - Street 1:3776 N MEADOWGATE CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-7990
Practice Address - Country:US
Practice Address - Phone:417-833-8253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009015903122300000X
MO2009013241122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty