NPIMap

Organization Active NPI

Dr. Kenneth Colbert DDS Inc

  • Dental Clinic/Center
  • Steelville, MO
National Provider Identifier
1174057178
Registry record updated Apr 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
013305 Issued in MO
Legal business name
DR. KENNETH COLBERT DDS INC
Practice address
PO Box Aq
204 W Main St
Steelville, MO 65565-0609
Phone
(573) 775-2636
NPI assigned
Apr 17, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2017

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

Authorized official

Name
Kenneth Colbert
Title
President
Phone
(573) 775-2636

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 013305 MO Primary

Addresses

Primary practice location

PO Box Aq
204 W Main St
Steelville, MO 65565-0609

Mailing address

PO Box Aq
204 W. Main St
Steelville, MO 65565-0609
Phone (573) 775-2636

Other identifiers 1

IdentifierTypeStateIssuer
4012188050MedicaidMO

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1492387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492387200000",
    "number": "1174057178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX AQ",
            "address_2": "204 W. MAIN ST",
            "city": "STEELVILLE",
            "state": "MO",
            "postal_code": "655650609",
            "telephone_number": "573-775-2636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX AQ",
            "address_2": "204 W MAIN ST",
            "city": "STEELVILLE",
            "state": "MO",
            "postal_code": "655650609",
            "telephone_number": "573-775-2636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. KENNETH COLBERT DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-17",
        "last_updated": "2017-04-17",
        "status": "A",
        "authorized_official_last_name": "COLBERT",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "573-775-2636"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MO",
            "license": "013305",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4012188050",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Steelville, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2017; 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.