Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 7005015640 | MO |
NPI | 1003929241 |
---|---|
Provider Name | Dr. Darren William Mahaffey |
First Address | Springfield, MO 65807-4121 |
Second Address | Springfield, MO 65807-4121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 08/07/2007 |