Individual
JEFFREY KYLE MAPLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1324 E MONTCLAIR ST, SPRINGFIELD, MO 65804-4245
(417) 886-9939
Mailing address
1324 E MONTCLAIR ST, SPRINGFIELD, MO 65804-4245
(417) 886-9939
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2017023599
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2017023599
STATE LICENSE OF MISSOURI
MO
Enumeration date
07/17/2017
Last updated
10/05/2018
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