| Otto Bean Dental Clinic | |
|
500 Russell St Kennett MO 63857-2102 | |
| (573) 888-3000 | |
| (573) 888-3003 |
| Full Name | Otto Bean Dental Clinic |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 500 Russell St, Kennett, Missouri |
| Authorized Official Name and Position | Chris Jones (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5737482404 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Otto Bean Dental Clinic 420 Semo Dr P.o. Box 400 New Madrid MO 63869-1734 Ph: (573) 748-2404 | Otto Bean Dental Clinic 500 Russell St Kennett MO 63857-2102 Ph: (573) 888-3000 |
| NPI Number | 1013229749 |
|---|---|
| Provider Enumeration Date | 07/10/2010 |
| Last Update Date | 08/06/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013229749 | NPI | - | NPPES |
| 1013229749 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Secondary |
Doing Business As Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 103 1st St, Kennett, MO 63857 Phone: 573-888-9944 Fax: 573-888-9789 | |
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 |