Provider Demographics
NPI:1306444740
Name:RESSEL FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:RESSEL FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:RESSEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-449-5149
Mailing Address - Street 1:1 E BROADWAY STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4205
Mailing Address - Country:US
Mailing Address - Phone:573-449-5968
Mailing Address - Fax:573-449-5149
Practice Address - Street 1:1 E BROADWAY STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4205
Practice Address - Country:US
Practice Address - Phone:573-449-5968
Practice Address - Fax:573-449-5149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1942650544OtherPROVIDER NPI