Organization
FOUNTAINVIEW DENTAL HARRISONVILLE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNE DEMMY (CREDENTIALING MANAGER)
(918) 998-0996
Entity
Organization
Contact information
Practice address
401 E MECHANIC ST, HARRISONVILLE, MO 64701-2427
(816) 887-2008
Mailing address
400 RIVERWALK TER STE 250, JENKS, OK 74037-5619
(918) 998-0996
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/24/2021
Last updated
06/28/2023
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