NPI 1104319862

Copper Creek LLC

Organisation Dental Clinic/Center Ozark, MO

Practice location

Address: 797 W South St, Ozark, MO 65721-9261
Phone: (417) 581-0835
Mailing address: 119 Jared Blvd, Webb City, MO 64870-9214

Authorised official

Name: Jonathan W Jacoby
Title: Dentist
Phone: (816) 863-7096

Registered specialties

Dental Clinic/Center Primary

Ambulatory Health Care Facilities Taxonomy 261QD0000X Licence 2015016758 (MO)

Other Clinic/Center providers in Missouri →

Registry record

NPI: 1104319862
Entity type: Organization
NPI issued: 7 Jun 2018
Record last updated: 7 Jun 2018

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.