Clear Creek Family Dental Rogersville

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

CLEAR CREEK FAMILY DENTAL ROGERSVILLE

Practice address

203 Jamestown Blvd Unit a
Rogersville, MO 65742-6526

Phone

(417) 929-0000

Fax

(417) 929-0009

NPI assigned

Jan 25, 2023

Last updated

Jan 25, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Samuel R Zimmer, DDSNPI 1245722479

Title

Dentist (Provider)

Phone

(417) 929-0000

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Samuel Reed Zimmer, DDS

  • Dentist
  • Ash Grove, MO
  • NPI 1245722479
  NPD Authorized official

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

{
    "created_epoch": "1674604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674604800000",
    "number": "1114633922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 JAMESTOWN BLVD UNIT A",
            "city": "ROGERSVILLE",
            "state": "MO",
            "postal_code": "657426526",
            "telephone_number": "417-929-0000",
            "fax_number": "417-929-0009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 JAMESTOWN BLVD UNIT A",
            "city": "ROGERSVILLE",
            "state": "MO",
            "postal_code": "657426526",
            "telephone_number": "417-929-0000",
            "fax_number": "417-929-0009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEAR CREEK FAMILY DENTAL ROGERSVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-25",
        "last_updated": "2023-01-25",
        "certification_date": "2023-01-25",
        "status": "A",
        "authorized_official_last_name": "ZIMMER",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DENTIST (PROVIDER)",
        "authorized_official_telephone_number": "417-929-0000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven R Barnes, FNP
• Kimberly Bergmann
• Melissa L Bias, MS, PLPC
• Jessica Burks, FNP-C
• Marvin Ray Butler, PA-C
• Jennifer Coffman
• James Willard Coker, PHARM.D.
• Lori Ann Cole, MS,OTR/L
• Stephanie Rose Davison, FNP-BC
• Oakley B. Downing, M.D.

• Dental Clinic/Center in Rogersville, MO
• Providers in Rogersville, MO by specialty
• Dental Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2023; 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.