Innovative Dental

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

2011016216 Issued in MO

Legal business name

INNOVATIVE DENTAL

Practice address

3424 S Culpepper CT
Springfield, MO 65804-3755

Phone

(417) 889-4746

NPI assigned

May 21, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Grant B Olson, DDS

Title

President/Owner

Phone

(417) 889-4746

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• George G Graham Jr., DDS

  • General Practice Dentistry
  • Springfield, MO
  • NPI 1225027923
  NPD (past)
• Taylor Nicole Jordan, DDS

  • General Practice Dentistry
  • Springfield, MO
  • NPI 1508352600
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1400630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400630400000",
    "number": "1043622368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3424 S CULPEPPER CT",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658043755",
            "telephone_number": "417-889-4746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3424 S CULPEPPER CT",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658043755",
            "telephone_number": "417-889-4746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-21",
        "last_updated": "2014-05-21",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "GRANT",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "417-889-4746",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "MO",
            "license": "2011016216",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL OFFICE",
            "identifier": "3424",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jared Vernell Ingle, PLPC
• Mary A Ingrassia-Payan Rosales, MS, LPC
• Robin M Inman, LMSW
• Alicia Marie Inmon, MSE, ATC, LAT
• Anthony Wayne Inmon, NP
• Insight Counseling Associates, LLC
• Jenifer Dawn Insley, MD
• Inspiring Hope Counseling, LLC
• Integrative Family Psychology
• Integrity Home Care, Inc

• Preferred Provider Organization in Springfield, MO
• Providers in Springfield, MO by specialty
• Preferred Provider Organization in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.