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1166 Banning St Marshfield MO 65706-1015 | |
| (417) 859-2400 | |
| (417) 831-0155 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1166 Banning St, Marshfield, Missouri |
| Authorized Official Name and Position | Kenneth Brooks Miller (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4178310150 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
440 E Tampa St Springfield MO 65806-1131 Ph: (417) 831-0150 | 1166 Banning St Marshfield MO 65706-1015 Ph: (417) 859-2400 |
| NPI Number | 1437336195 |
|---|---|
| Provider Enumeration Date | 01/24/2008 |
| Last Update Date | 12/02/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437336195 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Secondary |
Richard Benjamin Alvarez Dds, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 14303 State Highway 38, Marshfield, MO 65706 Phone: 417-859-0711 |