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1070 S Bishop Ave Unit B Rolla MO 65401 | |
| (573) 426-5447 | |
| (573) 426-5659 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1070 S Bishop Ave, Rolla, Missouri |
| Authorized Official Name and Position | Kari A Hicks (MANAGING DIRECTOR) |
| Authorized Official Contact | 4175011082 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 2933 Springfield MO 65801-2933 Ph: (417) 501-1082 | 1070 S Bishop Ave Unit B Rolla MO 65401 Ph: (573) 426-5447 |
| NPI Number | 1215241005 |
|---|---|
| Provider Enumeration Date | 08/04/2010 |
| Last Update Date | 01/08/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215241005 | NPI | - | NPPES |
| 100617150314027 | Medicaid | MO | |
| 504350307 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2006012741 (Missouri) | Primary |
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