COPPER CREEK LLC (NPI# 1104319862) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104319862 |
| Entity Type | Organization |
| Organization Name | COPPER CREEK LLC |
| Other Organization Name | COPPER CREEK DENTAL |
| Practice Address |
797 W South St Ozark MO 65721-9261 |
| Mailing Address |
119 Jared Blvd Webb City MO 64870-9214 |
| Practice Telephone | 4175810835 |
| Mailing Telephone | 8168637096 |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2018-06-07 |
| Authorized Official Name | DR. JONATHAN W JACOBY (DENTIST) |
| Authorized Official Telephone | 8168637096 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
2015016758 | MO | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Copper Creek Dental | Other Name - Individual/Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | COPPER CREEK LLC | Po Box 22, Whitesboro, Ny 13492 |
| Street Address |
797 W SOUTH ST |
| City | OZARK |
| State | MO |
| Zip Code | 65721-9261 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063054880 | Ramya Sravani Pakala | Family Medicine | 5571 N. 21st St., Ozark, MO 65721 | 2019-10-14 |
| 1871073346 | Regional Services | Nurse Practitioner | 1350 W Bluff Dr, Ozark, MO 65721 | 2018-08-15 |
| 1932602125 | Clarence William Jaggard Jr. | Family Medicine | Ozark Valley Medical Clinic 5571 N. 21st St., Ozark, MO 65721 | 2018-03-14 |
| 1053826750 | Veronica Keller | Speech-Language Pathologist | 3608 N. Highway Nn, Ozark, MO 65721 | 2017-12-05 |
| 1124546304 | Kara Nicole Peterson | Speech-Language Pathologist | 302 N 4th Ave., Ozark, MO 65721 | 2017-09-07 |
| 1912391368 | Mobile X-ray Services, LLC | Clinic/Center | 3050 N. 20th Street, Ozark, MO 65721 | 2015-03-24 |
| 1073787289 | Melissa Milan | Counselor | 332 South 3rd Street, Ozark, MO 65721 | 2008-04-17 |
| 1306038948 | Preferred Hospice of Missouri Southwest LLC | Hospice Care, Community Based | 1567 West Diane, Suite B, Ozark, MO 65721 | 2007-08-17 |
| 1508073040 | Retirement At Century Pines Inc. | Assisted Living Facility | 709 E. Mccracken, Ozark, MO 65721 | 2007-05-16 |
| 1184844482 | Ozark Medical Imaging Center | Radiology | 1500 W State Hwy J, Ozark, MO 65721 | 2007-04-27 |
| Find all providers in zip 65721 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124266812 | Jon C. Mann, D.m.d., LLC | Clinic/Center | 206 S 2nd Ave, Ozark, MO 65721-8467 | 2009-02-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306444740 | Ressel Family Dentistry LLC | Clinic/Center | 1 E Broadway Ste A, Columbia, MO 65203-4205 | 2020-10-16 |
| 1467059980 | Valudental Independence LLC | Clinic/Center | 600 E Us Highway 24, Independence, MO 64050-2910 | 2020-10-07 |
| 1144835828 | Rem Dds, LLC | Clinic/Center | 10000 Watson Rd Ste 2mm, Saint Louis, MO 63126-1848 | 2020-09-10 |
| 1043824832 | Pleasant Dental Care Kc | Clinic/Center | 912 E 63rd St Ste 100, Kansas City, MO 64110-3439 | 2020-08-31 |
| 1164033122 | Dental Depot of Blue Springs Pllc | Clinic/Center | 1500 S 7 Hwy, Blue Springs, MO 64014-3943 | 2020-08-13 |
| 1184235517 | Twin Creeks Family Dentistry LLC | Clinic/Center | 10560 N Ambassador Dr Ste 200, Kansas City, MO 64153-1591 | 2020-08-10 |
| 1003434234 | Jason L Allen Dmd LLC | Clinic/Center | 5147 Daggett Ave, Saint Louis, MO 63110-3009 | 2020-07-14 |
| 1538622071 | Smile Safari of Missouri | Clinic/Center | 10016 E 63rd St, Raytown, MO 64133-5102 | 2019-04-11 |
| 1275094864 | Itooth Family Dentistry, LLC | Clinic/Center | 3211 E Battlefield St Ste 100, Springfield, MO 65804-4071 | 2019-03-27 |
| 1033677901 | C. Hastings, Dds, LLC | Clinic/Center | 1709 Heritage Hills Dr, Washington, MO 63090-4621 | 2019-03-08 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.