Southeast Missouri Health Network

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SOUTHEAST MISSOURI HEALTH NETWORK

Doing business as

otto bean dental clinic

Practice address

500 Russell St
Kennett, MO 63857-2102

Phone

(573) 888-3000

Fax

(573) 888-3003

NPI assigned

Jul 10, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Chris Jones

Title

Chief Executive Officer

Phone

(573) 748-2404

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• otto bean dental clinic Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1278720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407283200000",
    "number": "1013229749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 SEMO DR",
            "address_2": "P.O. BOX 400",
            "city": "NEW MADRID",
            "state": "MO",
            "postal_code": "638691734",
            "telephone_number": "573-748-2404",
            "fax_number": "573-748-8929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 RUSSELL ST",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638572102",
            "telephone_number": "573-888-3000",
            "fax_number": "573-888-3003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST MISSOURI HEALTH NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-10",
        "last_updated": "2014-08-06",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "573-748-2404"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013229749",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "otto bean dental clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Valerie Marie Smith
• Eric Snipes, LPC
• Wuthisak Soonattrakul
• Soporex DME, Inc.
• Southaven Inc
• Southeast Missouri Health Network
• Southern Emergency Services I PLC
• Southern Emergency Services PLLC
• Loren Sowell
• Della Sparks

• General Practice Dentistry in Kennett, MO
• Providers in Kennett, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.