Provider Demographics
NPI:1164788014
Name:VERBIST, CALLIE BETH
Entity Type:Individual
Prefix:MRS
First Name:CALLIE
Middle Name:BETH
Last Name:VERBIST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 N. PROVIDENCE RD.
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4365
Mailing Address - Country:US
Mailing Address - Phone:573-777-8997
Mailing Address - Fax:
Practice Address - Street 1:1101 N. PROVIDENCE RD.
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4365
Practice Address - Country:US
Practice Address - Phone:573-777-8997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013014040122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist