Provider Demographics
NPI:1255868725
Name:MCCALL FAMILY DENTISTRY
Entity Type:Organization
Organization Name:MCCALL FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCCALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-425-3331
Mailing Address - Street 1:812 S 24TH ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:MO
Mailing Address - Zip Code:64424-2632
Mailing Address - Country:US
Mailing Address - Phone:660-425-3331
Mailing Address - Fax:660-425-3341
Practice Address - Street 1:812 S 24TH ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:MO
Practice Address - Zip Code:64424-2632
Practice Address - Country:US
Practice Address - Phone:660-425-3331
Practice Address - Fax:660-425-3341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental