Deatherage, Ted A
Deatherage, Ted A is an sole proprietor health care provider with primary practice located at 1616 Gibson St , West Plains MO 65775-1814. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Deatherage, Ted A can be contacted via phone (417) 257-0126.Contact Information
Primary practice address
1616 Gibson St
West Plains MO 65775-1814
Phone: (417) 257-0126
Fax: (417) 256-2469
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | DEA015659 | Missouri |
Profile Details
| NPI number | 1689721813 |
|---|---|
| LBN Legal business name | Deatherage, Ted A |
| Credentials | Doctor of Dental Medicine (DMD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 3rd, 2007 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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