Provider Demographics
NPI:1821386459
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:573-348-1466
Mailing Address - Fax:573-348-1581
Practice Address - Street 1:4320 OSAGE BEACH PKWY
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-2142
Practice Address - Country:US
Practice Address - Phone:573-348-1466
Practice Address - Fax:573-348-1581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty