Provider Demographics
NPI:1730369943
Name:MAHAFFEY FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:MAHAFFEY FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MAHAFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-887-3573
Mailing Address - Street 1:509 W BATTLEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-4121
Mailing Address - Country:US
Mailing Address - Phone:417-887-3573
Mailing Address - Fax:417-887-3585
Practice Address - Street 1:509 W BATTLEFIELD ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4121
Practice Address - Country:US
Practice Address - Phone:417-887-3573
Practice Address - Fax:417-887-3585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005015640122300000X
MO11799122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty