Provider Demographics
NPI:1982232849
Name:CAPE GIRARDEAU DENTISTRY, LLC
Entity Type:Organization
Organization Name:CAPE GIRARDEAU DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-334-8798
Mailing Address - Street 1:2906 BRECKENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-1728
Mailing Address - Country:US
Mailing Address - Phone:573-334-8798
Mailing Address - Fax:573-334-1370
Practice Address - Street 1:2906 BRECKENRIDGE DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-1728
Practice Address - Country:US
Practice Address - Phone:573-334-8798
Practice Address - Fax:573-334-1370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental