| Bootheel Dental Clinic | |
|
202b Main St New Madrid MO 63869-1911 | |
| (573) 748-5671 | |
| (573) 748-5317 |
| Full Name | Bootheel Dental Clinic |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 202b Main St, New Madrid, Missouri |
| Authorized Official Name and Position | Christopher Jones (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 5737482404 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bootheel Dental Clinic 420 Semo Dr P.o. Box 400 New Madrid MO 63869-1734 Ph: (573) 748-2404 | Bootheel Dental Clinic 202b Main St New Madrid MO 63869-1911 Ph: (573) 748-5671 |
| NPI Number | 1457570681 |
|---|---|
| Provider Enumeration Date | 04/25/2007 |
| Last Update Date | 07/22/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457570681 | NPI | - | NPPES |
| 500704069 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (NU) | Primary |
| 1223G0001X | Dentist - General Practice | (NU) | Secondary |
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