Provider Demographics
NPI:1427071950
Name:STRUBLE, DAVID ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALLEN
Last Name:STRUBLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-9164
Mailing Address - Country:US
Mailing Address - Phone:417-581-2421
Mailing Address - Fax:417-485-2420
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO142761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice