Provider Demographics
NPI:1306173612
Name:GREATER SPRINGFIELD ENDODONTICS
Entity type:Organization
Organization Name:GREATER SPRINGFIELD ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MSD
Authorized Official - Phone:417-883-7668
Mailing Address - Street 1:2808 S INGRAM MILL RD
Mailing Address - Street 2:BUILDING C108
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4079
Mailing Address - Country:US
Mailing Address - Phone:417-883-7668
Mailing Address - Fax:417-883-8525
Practice Address - Street 1:2808 S INGRAM MILL RD
Practice Address - Street 2:BUILDING C108
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4079
Practice Address - Country:US
Practice Address - Phone:417-883-7668
Practice Address - Fax:417-883-8525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental