NPI | 1972649986 |
---|---|
Doing Business As | NORTHEAST MISSOURI DENTAL CLINIC |
Entity Type | Organization |
Authorized Contact | ANDREW H. GRIMM Executive Director 660-627-5757 |
Organization Subpart ? | Yes |
Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: MO 2001012903) |
1223D0001X Dentist, Dental Public Health (Licence: MO 2006007559) | |
124Q00000X Dental Hygienist (Licence: MO 003847) | |
Enumeration Date | 2007-01-29 |
Last Update Date | 2012-10-12 |