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MICAH DANIELLE ADCOCK NP

Dental Providers Dentist General Practice

Provider NPI: 1992364871

Provider Information:
 MICAH DANIELLE ADCOCK NP
Gender: F
Not Sole Proprietor

Practice Location:
440 E TAMPA ST  SPRINGFIELD, MO 65806-1131 US
Tel: 417-831-0150  Fax: 417-868-8263

Business Mailing Address:
2113 CAMBRIDGE DR  WEST PLAINS, MO 65775-1974 US
Tel: 417-293-7307  Fax: --

NPI Information:
NPI: 1992364871
Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
Dentist
General Practice
MO2019018801

Other Provider Identifiers:

IssuerNumberStateType
MISSOURI PROFESSIONAL LICENSE2019018801MO01



American Medical Association 2012 taxonomy code information

Code: 1223G0001X

Type:

Classification:



Definition:



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