Individual
MARK ROY BAGBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2935 BAGNELL DAM BLVD STE 112, LAKE OZARK, MO 65049-8661
(578) 349-9578
Mailing address
PO BOX 2546, LAKE OZARK, MO 65049-2546
(573) 578-3499
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
15287
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
403024805
—
MO
Enumeration date
05/31/2007
Last updated
07/25/2024
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