TW Practice Partners Missouri PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

TW PRACTICE PARTNERS MISSOURI PC

Doing business as

ROLLA FAMILY DENTISTRY

Practice address

1701 E 10TH St
Rolla, MO 65401-4601

Phone

(573) 364-1599

NPI assigned

Nov 2, 2023

Organization subpart

No

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

Authorized official

Name

Ryan McCostlin

Title

Ceo

Phone

(615) 479-2196

Specialties & licenses 1

Addresses

Other names 1

• ROLLA FAMILY DENTISTRY Doing business as

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

{
    "created_epoch": "1698883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698883200000",
    "number": "1609649524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 BURTON HILLS BLVD STE 400",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372153004",
            "telephone_number": "615-479-2196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 E 10TH ST",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654014601",
            "telephone_number": "573-364-1599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TW PRACTICE PARTNERS MISSOURI PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-02",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A",
        "authorized_official_last_name": "MCCOSTLIN",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "615-479-2196"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ROLLA FAMILY DENTISTRY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Rolla, MO
• Providers in Rolla, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2023; 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.