NPI 1043622368

Innovative Dental

Organisation Preferred Provider Organization Springfield, MO

Practice location

Address: 3424 S Culpepper CT, Springfield, MO 65804-3755
Phone: (417) 889-4746

Authorised official

Name: Grant B Olson
Title: President/Owner
Phone: (417) 889-4746

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 2011016216 (MO)

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Registry record

NPI: 1043622368
Entity type: Organization
NPI issued: 21 May 2014
Record last updated: 21 May 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.