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Organization

GRAND DENTAL STUDIO LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
NICHOLAS R MATTHEWS DDS (OWNER/DENTIST)
(417) 865-8405
Entity
Organization

Contact information

Practice address
948 S JEFFERSON AVE, SPRINGFIELD, MO 65806-3204
(417) 861-8876
Mailing address
948 S JEFFERSON AVE, SPRINGFIELD, MO 65806-3204
(417) 865-8405

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary

Other

Enumeration date
08/04/2022
Last updated
03/29/2023
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