Provider Demographics
NPI:1992955405
Name:GREATER SPRINGFIELD ENDODONTICS PARTNERSHIP
Entity type:Organization
Organization Name:GREATER SPRINGFIELD ENDODONTICS PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
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:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0158641223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty