| Formanek DDS LLC | |
|
2226 Missouri Blvd Jefferson City MO 65109-4727 | |
| (573) 658-4022 | |
| Not Available |
| Full Name | Formanek DDS LLC |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2226 Missouri Blvd, Jefferson City, Missouri |
| Authorized Official Name and Position | Joseph Formanek (OWNER) |
| Authorized Official Contact | 5736584022 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Formanek DDS LLC Po Box 70887 Cleveland OH 44190-7088 | Formanek DDS LLC 2226 Missouri Blvd Jefferson City MO 65109-4727 Ph: (573) 658-4022 |
| NPI Number | 1508355900 |
|---|---|
| Provider Enumeration Date | 05/02/2018 |
| Last Update Date | 06/13/2023 |
| Certification Date | 06/13/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508355900 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (NU) | Primary |
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