Hermitage Dental Cener | |
303 Spring St Hermitage MO 65668-0105 | |
(417) 745-2134 | |
(417) 745-2135 |
Full Name | Hermitage Dental Cener |
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Speciality | Dentist - General Practice |
Location | 303 Spring St, Hermitage, Missouri |
Authorized Official Name and Position | James C Fusco (DENTIST/OWNER) |
Authorized Official Contact | 4177452134 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Hermitage Dental Cener Po Box 105 Hermitage MO 65668-0105 Ph: (417) 745-2134 | Hermitage Dental Cener 303 Spring St Hermitage MO 65668-0105 Ph: (417) 745-2134 |
NPI Number | 1275707135 |
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Provider Enumeration Date | 04/22/2008 |
Last Update Date | 04/22/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1275707135 | NPI | - | NPPES |
406679209 | Medicaid | MO | |
187734 | Other | MO | DORAL DENTAL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | DE015502 (Missouri) | Primary |