Bootheel Dental Clinic | |
202b Main St New Madrid MO 63869-1911 | |
(573) 748-5671 | |
(573) 748-5317 |
Full Name | Bootheel Dental Clinic |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 202b Main St, New Madrid, Missouri |
Authorized Official Name and Position | Christopher Jones (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 5737482404 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Bootheel Dental Clinic 420 Semo Dr P.o. Box 400 New Madrid MO 63869-1734 Ph: (573) 748-2404 | Bootheel Dental Clinic 202b Main St New Madrid MO 63869-1911 Ph: (573) 748-5671 |
NPI Number | 1457570681 |
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Provider Enumeration Date | 04/25/2007 |
Last Update Date | 07/22/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1457570681 | NPI | - | NPPES |
500704069 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |