Organization
COPPER CREEK LLC
Active
Other names
Copper Creek Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN W JACOBY DDS (DENTIST)
(816) 863-7096
Entity
Organization
Contact information
Practice address
797 W SOUTH ST, OZARK, MO 65721-9261
(417) 581-0835
Mailing address
119 JARED BLVD, WEBB CITY, MO 64870-9214
(816) 863-7096
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
2015016758
MO
Other
Enumeration date
06/07/2018
Last updated
06/07/2018
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