Copper Creek LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

2015016758 Issued in MO

Legal business name

COPPER CREEK LLC

Practice address

797 W South St
Ozark, MO 65721-9261

Phone

(417) 581-0835

NPI assigned

Jun 7, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Jonathan W Jacoby, DDS

Title

Dentist

Phone

(816) 863-7096

Specialties & licenses 1

Addresses

Other names 1

• Copper Creek Dental Other name

Locations

Practitioners 1

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

• Justin Anderson, DDS

  • Dentist
  • Nixa, MO
  • NPI 1518343102
  NPD (past)

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

{
    "created_epoch": "1528329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528329600000",
    "number": "1104319862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 JARED BLVD",
            "city": "WEBB CITY",
            "state": "MO",
            "postal_code": "648709214",
            "telephone_number": "816-863-7096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "797 W SOUTH ST",
            "city": "OZARK",
            "state": "MO",
            "postal_code": "657219261",
            "telephone_number": "417-581-0835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COPPER CREEK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-07",
        "last_updated": "2018-06-07",
        "status": "A",
        "authorized_official_last_name": "JACOBY",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "816-863-7096",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MO",
            "license": "2015016758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Copper Creek Dental",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Carl Chris Clausen, R.PH.
• Dana Claire Clevenger, CRNA
• Caitlin M Cole, FNP
• Alexandria E Collins
• Lester L Conduff, MD
• Cornerstone Caregiving East LLC
• Dustin Cox
• Kasey Crewse
• Curtis D Inman DDS PC
• Cynthia N Dancey, PA

• Dental Clinic/Center in Ozark, MO
• Providers in Ozark, MO by specialty
• Dental Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2018; 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.