NPIMap

Organization Active NPI

Dental Wellness Partners LLC

  • Dental Clinic/Center
  • Columbia, MO
National Provider Identifier
1205699097
Registry record updated Feb 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
DENTAL WELLNESS PARTNERS LLC
Doing business as
Summit Dental
Practice address
2310 Forum Blvd Apt a
Columbia, MO 65203-5461
Phone
(573) 446-0032
NPI assigned
Feb 5, 2024
Organization subpart
Yes
Parent organization
DENTAL WELLNESS PARTNERS LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 5, 2024

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

Authorized official

Name
Misty Williams, DDS
Title
Partner/Dentist
Phone
(573) 355-4856

Specialties & licenses 1

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

Addresses

Primary practice location

2310 Forum Blvd Apt a
Columbia, MO 65203-5461

Mailing address

2310 Forum Blvd Apt a
Columbia, MO 65203-5461

Other identifiers 1

IdentifierTypeStateIssuer
1194138362MedicaidMO

Other names 1

  • Summit Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Wellness Partners LLC2 organizations share this tax ID, including this one
Part of
Dental Wellness Partners LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1707091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707091200000",
    "number": "1205699097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2310 FORUM BLVD APT A",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652035461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 FORUM BLVD APT A",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652035461",
            "telephone_number": "573-446-0032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL WELLNESS PARTNERS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL WELLNESS PARTNERS LLC",
        "enumeration_date": "2024-02-05",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-03",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "MISTY",
        "authorized_official_title_or_position": "PARTNER/DENTIST",
        "authorized_official_telephone_number": "573-355-4856",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194138362",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summit Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2024; 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.