Provider Demographics
NPI:1922212778
Name:DANIEL G. TEUBNER, D.D.S.,PC
Entity Type:Organization
Organization Name:DANIEL G. TEUBNER, D.D.S.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:TEUBNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-635-5525
Mailing Address - Street 1:1801 STADIUM BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-1947
Mailing Address - Country:US
Mailing Address - Phone:573-635-5525
Mailing Address - Fax:573-634-4808
Practice Address - Street 1:1801 STADIUM BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-1947
Practice Address - Country:US
Practice Address - Phone:573-635-5525
Practice Address - Fax:573-634-4808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO143421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========OtherFEDERAL TAX ID