| 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 |