| Northside Dental Clinic | |
|
2105 W Kearney St Suite A Springfield MO 65803-1652 | |
| (417) 862-2468 | |
| (417) 863-6775 |
| Full Name | Northside Dental Clinic |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2105 W Kearney St, Springfield, Missouri |
| Authorized Official Name and Position | Derek Kaelin, Dds (OWNER/DENTIST) |
| Authorized Official Contact | 4178622468 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northside Dental Clinic 2105 W Kearney St Suite A Springfield MO 65803-1652 Ph: (417) 862-2468 | Northside Dental Clinic 2105 W Kearney St Suite A Springfield MO 65803-1652 Ph: (417) 862-2468 |
| NPI Number | 1922401793 |
|---|---|
| Provider Enumeration Date | 10/07/2014 |
| Last Update Date | 10/07/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922401793 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 2003017125 (Missouri) | Primary |
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