Provider Demographics
NPI:1811761190
Name:DENTAL SAFARI CO MISSOURI, PC
Entity type:Organization
Organization Name:DENTAL SAFARI CO MISSOURI, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:618-559-6662
Mailing Address - Street 1:7562 OLD ROUTE 13
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-7776
Mailing Address - Country:US
Mailing Address - Phone:618-993-8333
Mailing Address - Fax:618-993-8335
Practice Address - Street 1:7827 TOWN SQUARE AVE STE 104-1125
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7197
Practice Address - Country:US
Practice Address - Phone:618-993-8333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty