Provider Demographics
NPI:1790971976
Name:JOPLIN SURGICAL ARTS, LLC
Entity Type:Organization
Organization Name:JOPLIN SURGICAL ARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-621-0500
Mailing Address - Street 1:620 W 32ND ST STE B
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-2526
Mailing Address - Country:US
Mailing Address - Phone:417-781-4551
Mailing Address - Fax:417-781-5809
Practice Address - Street 1:620 W 32ND ST STE B
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2526
Practice Address - Country:US
Practice Address - Phone:417-781-4551
Practice Address - Fax:417-781-5809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207-0261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical