Provider Demographics
NPI:1104514322
Name:DENTAQ
Entity type:Organization
Organization Name:DENTAQ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BOBBYE
Authorized Official - Middle Name:
Authorized Official - Last Name:BATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-830-0475
Mailing Address - Street 1:2305 S BLACKMAN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65809-2845
Mailing Address - Country:US
Mailing Address - Phone:417-887-3860
Mailing Address - Fax:417-877-7749
Practice Address - Street 1:1136 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-9164
Practice Address - Country:US
Practice Address - Phone:417-581-2421
Practice Address - Fax:417-485-2420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty