# COPPER CREEK LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Copper Creek Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104319862
- **Authorized official:** DR. JONATHAN W JACOBY DDS (DENTIST)
- **Authorized official phone:** (816) 863-7096

## Contact information

- **Practice address:** 797 W SOUTH ST, OZARK, MO 65721-9261
- **Practice address phone:** (417) 581-0835
- **Mailing address:** 119 JARED BLVD, WEBB CITY, MO 64870-9214
- **Mailing address phone:** (816) 863-7096

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 2015016758 | MO | Yes |

## Other

- **Enumeration date:** 06/07/2018
- **Last updated:** 06/07/2018