NORTHSIDE DENTAL L.L.C. NPI 1922401793

NPI Information

NPI: 1922401793
Provider Name: NORTHSIDE DENTAL L.L.C.

Doing Business As: NORTHSIDE DENTAL CLINIC

Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
2105 W KEARNEY ST
SUITE A
SPRINGFIELD, MO
ZIP 65803
Phone: (417) 862-2468
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NORTHSIDE DENTAL L.L.C. is a dental clinic center in Springfield, MO. NORTHSIDE DENTAL L.L.C. NPI is 1922401793. The provider is registered as an organization entity type.
The provider Is Doing Business As Northside Dental Clinic.

The provider's business location address is:

2105 W KEARNEY ST
SUITE A
SPRINGFIELD, MO
ZIP 65803-652
Phone: (417) 862-2468
Fax: (417) 863-6775

The provider's authorized official is Derek Kaelin, Dds .
The authorized official title is Owner/dentist and has the following contact phone number (417) 862-2468.

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

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
1	261QD0000X	Clinic/Center	Dental	2003017125	MISSOURI	Yes

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: 4/28/2024

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