NPIMap

Organization Active NPI

Buffalo Prairie Dental

  • Dentist
  • Buffalo, MO
National Provider Identifier
1912276809
Registry record updated Dec 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
012536 Issued in MO
Legal business name
BUFFALO PRAIRIE DENTAL
Practice address
1006 S. Ash
Buffalo, MO 65622-0707
Phone
(417) 345-2793
Fax
(417) 345-8654
NPI assigned
Dec 21, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2011

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

Authorized official

Name
Carol Jean Throckmorton
Title
Office Manager
Phone
(417) 345-2793

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 012536 MO Primary

Addresses

Primary practice location

1006 S. Ash
Buffalo, MO 65622-0707

Mailing address

PO Box 707
1006 S. Ash
Buffalo, MO 65622-0707
Phone (417) 345-2793

National Provider Directory

National Provider Directory

Locations

1006 S Ash St
Buffalo, MO 65622
Phone (417) 345-2793

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1324425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324425600000",
    "number": "1912276809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 707",
            "address_2": "1006 S. ASH",
            "city": "BUFFALO",
            "state": "MO",
            "postal_code": "656220707",
            "telephone_number": "417-345-2793",
            "fax_number": "417-345-8654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1006 S. ASH",
            "city": "BUFFALO",
            "state": "MO",
            "postal_code": "656220707",
            "telephone_number": "417-345-2793",
            "fax_number": "417-345-8654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUFFALO PRAIRIE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-21",
        "last_updated": "2011-12-21",
        "status": "A",
        "authorized_official_last_name": "THROCKMORTON",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "417-345-2793"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MO",
            "license": "012536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2011; 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.