| Doing Business As | |
|
103 1st St Kennett MO 63857-2051 | |
| (573) 888-9944 | |
| (573) 888-9789 |
| Full Name | Doing Business As |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 103 1st St, Kennett, Missouri |
| Authorized Official Name and Position | Misti Ross (INS DIRECTOR) |
| Authorized Official Contact | 8703363732 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Doing Business As 1804 Old Greensboro Rd Bldg B Jonesboro AR 72405-0003 Ph: (870) 336-3732 | Doing Business As 103 1st St Kennett MO 63857-2051 Ph: (573) 888-9944 |
| NPI Number | 1366797953 |
|---|---|
| Provider Enumeration Date | 07/19/2012 |
| Last Update Date | 10/14/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366797953 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
Otto Bean Dental Clinic Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 500 Russell St, Kennett, MO 63857 Phone: 573-888-3000 Fax: 573-888-3003 | |
Burcham Dental Arts Clinic Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 205 Teaco Rd, Kennett, MO 63857 Phone: 573-888-3521 Fax: 573-888-0973 |