Northeast Missouri Dental Clinic is a dental clinic (Clinic/center - Federally Qualified Health Center (fqhc)) in Kirksville, Missouri. The current practice location for Northeast Missouri Dental Clinic is 402 W Jefferson St, Kirksville, Missouri. For appointments, you can reach them via phone at
(660) 665-2741. The mailing address for Northeast Missouri Dental Clinic is 1416 Crown Dr, P O Box 1027, Kirksville, Missouri and phone number is (660) 627-5757.
Northeast Missouri Dental Clinic is licensed to practice in Missouri (license number ) and its
NPI number is 1972649986. This medical practice
does not participate in medicare program and thus may not accept your medicare insurance. You may check if they accept your insurance at
(660) 665-2741.
Dental Care Clinic Profile
| Full Name | Northeast Missouri Dental Clinic |
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| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
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| Location | 402 W Jefferson St, Kirksville, Missouri |
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| Authorized Official Name and Position | Andrew H. Grimm (EXECUTIVE DIRECTOR) |
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| Authorized Official Contact | 6606275757 |
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| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
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Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Northeast Missouri Dental Clinic
1416 Crown Dr
P O Box 1027
Kirksville
MO 63501-2548
Ph: (660) 627-5757 | Northeast Missouri Dental Clinic
402 W Jefferson St
Kirksville
MO 63501-3407
Ph: (660) 665-2741 |
NPI Details:
| NPI Number | 1972649986 |
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| Provider Enumeration Date | 01/29/2007 |
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| Last Update Date | 10/12/2012 |
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Medical Identifiers
Medical identifiers for Northeast Missouri Dental Clinic such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1972649986 | NPI | - | NPPES |
| 507477404 | Medicaid | MO | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 1223D0001X | Dentist - Dental Public Health | 2001012903 (Missouri) | Secondary |
| 1223D0001X | Dentist - Dental Public Health | 2006007559 (Missouri) | Secondary |
| 124Q00000X | Dental Hygienist | 003847 (Missouri) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Missouri) | Primary |
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