| Northside Family Dentistry | |
|
472 Highway P O Fallon MO 63366-1591 | |
| (636) 431-8600 | |
| (636) 215-8296 |
| Full Name | Northside Family Dentistry |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 472 Highway P, O Fallon, Missouri |
| Authorized Official Name and Position | Kim Jimenez (OFFICE MANAGER) |
| Authorized Official Contact | 6364318600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northside Family Dentistry 472 Highway P O Fallon MO 63366-1591 Ph: (636) 431-8600 | Northside Family Dentistry 472 Highway P O Fallon MO 63366-1591 Ph: (636) 431-8600 |
| NPI Number | 1811773674 |
|---|---|
| Provider Enumeration Date | 09/06/2023 |
| Last Update Date | 09/19/2023 |
| Certification Date | 09/19/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811773674 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | () | Primary |
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