| Expedition Pediatric Dentistry & Orthodontics | |
|
1250 E Walnut Lawn St Springfield MO 65804-4202 | |
| (417) 396-7318 | |
| Not Available |
| Full Name | Expedition Pediatric Dentistry & Orthodontics |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1250 E Walnut Lawn St, Springfield, Missouri |
| Authorized Official Name and Position | Jesse Nathaniel Gardner (OWNER) |
| Authorized Official Contact | 4177197862 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Expedition Pediatric Dentistry & Orthodontics 1250 E Walnut Lawn St Springfield MO 65804-4202 Ph: (417) 396-7318 | Expedition Pediatric Dentistry & Orthodontics 1250 E Walnut Lawn St Springfield MO 65804-4202 Ph: (417) 396-7318 |
| NPI Number | 1437558137 |
|---|---|
| Provider Enumeration Date | 08/19/2014 |
| Last Update Date | 12/11/2024 |
| Certification Date | 12/11/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437558137 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 2012019137 (Missouri) | Primary |
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