| Organization Name: | JON C. MANN, D.M.D., LLC |
| NPI Number: | 1124266812 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JON C MANN (PRESIDENT) |
| Mailing Address: | 206 S 2nd Ave Ozark |
| State: | MO US |
| Postal Code: | 657218467 |
| Phone Number: | 4175812430 |
| Fax Number: | 4175815235 |
| NPI Enumeration Date: | 02/03/2009 |
| NPI Last Update Date: | 02/03/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 16094 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |