Formanek DDS LLC
NPI #1508355900 in Jefferson City, Missouri
Provider Information
- NPI Number
- 1508355900
- Entity Type
- Organization
- Organization Name
- Formanek DDS LLC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- May 2, 2018
- Last Updated
- Jun 13, 2023
Practice Location
- Address
- 2226 MISSOURI BLVD
- City
- Jefferson City
- State
- Missouri
- ZIP Code
- 65109-4727
- Phone
- (573) 658-4022
Authorized Official
- Name
- JOSEPH FORMANEK
- Title
- OWNER
- Phone
- (573) 658-4022
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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