Provider Demographics
NPI:1649589706
Name:ACCESS DENTAL SERVICES LP
Entity Type:Organization
Organization Name:ACCESS DENTAL SERVICES LP
Other - Org Name:ACCESS DENTAL & DENTURES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR ADMINISTRATOR
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:PO BOX 2933
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2933
Mailing Address - Country:US
Mailing Address - Phone:417-501-1048
Mailing Address - Fax:417-501-1661
Practice Address - Street 1:1701 W SUNSHINE ST STE Q
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-2261
Practice Address - Country:US
Practice Address - Phone:417-501-1048
Practice Address - Fax:417-501-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-06
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060127411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1427356989OtherTYPE 2 NPI ACCESS DENTAL & DENTURES SPRINGFIELD
MO1215241005OtherACCESS DENTAL & DENTURES (ROLLA)
MO1821386459OtherACCESS DENTAL & DENTURES (OSAGE BEACH)
MO1376088369OtherTYPE 2 NPI FOR ACCESS DENTAL & DENTURES (MTG)
MO1811210487OtherTHAYER DENTAL CLINIC
MO1821386459OtherACCESS DENTAL & DENTURES (OSAGE BEACH)
MO1427356989OtherTYPE 2 NPI ACCESS DENTAL & DENTURES SPRINGFIELD