Vernon Dental Clinic

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

VERNON DENTAL CLINIC

Doing business as

King Dental Clinic

Practice address

102 E 9TH St
Eldon, MO 65026-1605

Phone

(573) 392-3886

Fax

(573) 392-5867

NPI assigned

Dec 30, 2020

Last updated

Jan 4, 2021By 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. Caitlyn Vernon, DDSNPI 1205355039

Title

Dentist

Phone

(573) 392-3886

Specialties & licenses 1

Addresses

Other names 1

• King Dental Clinic Doing business as

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.

• Caitlyn Vernon

  • General Practice Dentistry
  • Eldon, MO
  • NPI 1205355039
  NPD Authorized official

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

{
    "created_epoch": "1609286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609718400000",
    "number": "1265029797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 E 9TH ST",
            "city": "ELDON",
            "state": "MO",
            "postal_code": "650261605",
            "telephone_number": "573-392-3886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 E 9TH ST",
            "city": "ELDON",
            "state": "MO",
            "postal_code": "650261605",
            "telephone_number": "573-392-3886",
            "fax_number": "573-392-5867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VERNON DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-30",
        "last_updated": "2021-01-04",
        "certification_date": "2021-01-04",
        "status": "A",
        "authorized_official_last_name": "VERNON",
        "authorized_official_first_name": "CAITLYN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "573-392-3886",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "King Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John M Stalker Jr., LPC
• Kristen Shavaughn Stampehl, NP-C
• Sunbrook Management (Lee House of Eldon, LLC)
• Marilyn J Sunde
• Laura M Thompson, NP-C
• Caitlyn Vernon
• Josetta Eliese Wahwassuck, MSN, FNP, PMHNP
• Wal-Mart Stores East, LP (Walmart Pharmacy 10-0044)
• Anna Marie Walker, LPC
• Pamela J Wall, LMT

• Dental Clinic/Center in Eldon, MO
• Providers in Eldon, 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 4, 2021; 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.