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SOUTHEAST MISSOURI HEALTH NETWORK NPI 1013229749


NPI Information

NPI: 1013229749
Provider Name: SOUTHEAST MISSOURI HEALTH NETWORK

Doing Business As: OTTO BEAN DENTAL CLINIC

Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

Address:
500 RUSSELL ST
KENNETT, MO
ZIP 63857
Phone: (573) 888-3000
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SOUTHEAST MISSOURI HEALTH NETWORK is a general practice dentist in Kennett, MO. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. SOUTHEAST MISSOURI HEALTH NETWORK NPI is 1013229749. The provider is registered as an organization entity type.
The provider Is Doing Business As Otto Bean Dental Clinic.

The provider's business location address is:

500 RUSSELL ST
KENNETT, MO
ZIP 63857-102
Phone: (573) 888-3000
Fax: (573) 888-3003

The provider's authorized official is Chris Jones .
The authorized official title is Chief Executive Officer and has the following contact phone number (573) 748-2404.

The enumeration date for this NPI number is 7/10/2010 and was last updated on 8/6/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QF0400XClinic/CenterFederally Qualified Health Center (FQHC)No
21223G0001XDentistGeneral PracticeYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11013229749MEDICAIDMISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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