Melissa Boerema, D.D.S
Individual provider Active NPI General Practice Dentistry · Butler, MO
NPI 1457640641 · NPPES record last updated Oct 20, 2022
Key facts
- NPI
- 1457640641
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 2010017989 (MO)
- Practice address
- 205 E Dakota St
Butler, MO 64730-2113 - Phone
- (844) 853-8937
- NPI assigned
- Mar 29, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221019001652 | MO | Practitioner - Dentist | 6709195902 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61142 | KS | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Compass Health, Inc | Current |
Accepting new patients | |
| Compass Health, Inc | Current |
Accepting new patients | |
| Arbor Creek Dental PA | Past | Accepting new patients |
Locations
205 E Dakota St
Butler, MO 64730
Phone (660) 679-4636
1800 Community
Clinton, MO 64735
Phone (660) 885-8131
2000 N Gaines Dr
Clinton, MO 64735
Phone (660) 885-6933
1800 Community
#B
Clinton, MO 64735
107 W Broadway St
El Dorado Springs, MO 64744
Phone (417) 876-5314
301 W Austin Blvd
Nevada, MO 64772
101 Hospital Dr
Osceola, MO 64776
Phone (417) 646-2054
501 N Sunset Ln
Raymore, MO 64083
Phone (448) 538-9378
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 61142 | KS | |
| General Practice Dentistry | 1223G0001X | 2010017989 | MO | Yes |
Addresses
Primary practice location
205 E Dakota St
Butler, MO 64730-2113
Mailing address
1800 Community
Clinton, MO 64735-8804
Phone (660) 885-8131
Other practice location 1
501 N Sunset Ln
Raymore, MO 64083-9402
Phone (844) 853-8937
Other practice location 2
101 Hospital Dr
Osceola, MO 64776-9547
Phone (844) 853-8937
Other practice location 3
107 Broadway Street
El Dorado Springs, MO 64744-1133
Phone (844) 853-8937
Other practice location 4
1800 Community
Clinton, MO 64735-8804
Phone (844) 853-8937
Other practice location 5
301 W Austin Blvd
Nevada, MO 64772-3124
Phone (844) 853-8937
Other practice location 6
2000 N Gaines Dr
Clinton, MO 64735-1132
Phone (448) 538-9378
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 405546102 | Medicaid | MO |
Other providers in Butler, MO
- Bates County Memorial Hospital Ambulance
- Bates County Memorial Hospital Pharmacy
- Michelle R. Bearce
- Jeffrey W Bissing
- Body Beautiful
- Timothy Brannon
- Breezy Meadows, LLC
- Breezy Operations LLC
- Miranda Leigh Bridges
- Bristol Care, Inc.
All providers in Butler, MO · General Practice Dentistry in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 20, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.