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168 S Payne Stewart Dr Ste 100 Branson MO 65616-2792 | |
| (417) 414-0011 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 168 S Payne Stewart Dr, Branson, Missouri |
| Authorized Official Name and Position | Mark Dake (OWNER) |
| Authorized Official Contact | 5017812777 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 24470 Little Rock AR 72221-4470 Ph: (501) 781-2777 | 168 S Payne Stewart Dr Ste 100 Branson MO 65616-2792 Ph: (417) 414-0011 |
| NPI Number | 1326425711 |
|---|---|
| Provider Enumeration Date | 05/05/2015 |
| Last Update Date | 05/05/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326425711 | NPI | - | NPPES |
| 1043609522 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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