Provider Demographics
NPI:1275048324
Name:ACCESS DENTAL & DENTURES LLC
Entity Type:Organization
Organization Name:ACCESS DENTAL & DENTURES LLC
Other - Org Name:ACCESS DENTAL & DENTURES LLC (OSCEOLA)
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-501-1048
Mailing Address - Street 1:1701 W SUNSHINE ST STE Q
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-2261
Mailing Address - Country:US
Mailing Address - Phone:417-501-1048
Mailing Address - Fax:417-501-1661
Practice Address - Street 1:286 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:MO
Practice Address - Zip Code:64776-2930
Practice Address - Country:US
Practice Address - Phone:417-501-1048
Practice Address - Fax:417-501-1661
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACCESS DENTAL & DENTURES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty