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INNOVATIVE DENTAL NPI 1043622368


NPI Information

NPI: 1043622368
Provider Name: INNOVATIVE DENTAL
Classification: Preferred Provider Organization - 305R00000X
Entity Type: Organization
Address:
3424 S CULPEPPER CT
SPRINGFIELD, MO
ZIP 65804
Phone: (417) 889-4746
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INNOVATIVE DENTAL is a preferred provider organization in Springfield, MO. The provider is a group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. INNOVATIVE DENTAL NPI is 1043622368. The provider is registered as an organization entity type.

The provider's business location address is:

3424 S CULPEPPER CT
SPRINGFIELD, MO
ZIP 65804-755
Phone: (417) 889-4746

The provider's authorized official is Grant B Olson .
The authorized official title is President/owner and has the following contact phone number (417) 889-4746.

The enumeration date for this NPI number is 5/21/2014 and was last updated on 5/21/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1305R00000XPreferred Provider Organization2011016216MISSOURIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
13424OTHERDENTAL OFFICE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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