Formanek Dds Llc | |
2226 Missouri Blvd Jefferson City MO 65109-4727 | |
(573) 658-4022 | |
Not Available |
Full Name | Formanek Dds Llc |
---|---|
Speciality | Dentist - General Practice |
Location | 2226 Missouri Blvd, Jefferson City, Missouri |
Authorized Official Name and Position | Joseph Formanek (OWNER) |
Authorized Official Contact | 5736584022 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Formanek Dds Llc Po Box 70887 Cleveland OH 44190-7088 Ph: () - | Formanek Dds Llc 2226 Missouri Blvd Jefferson City MO 65109-4727 Ph: (573) 658-4022 |
NPI Number | 1508355900 |
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Provider Enumeration Date | 05/02/2018 |
Last Update Date | 06/13/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1508355900 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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