NPIMap

Organization Active NPI

Northside Dental Clinic

  • General Practice Dentistry
  • Springfield, MO
National Provider Identifier
1538288071
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
10691 Issued in MO
Legal business name
NORTHSIDE DENTAL CLINIC
Practice address
2105 W Kearney St
Suite a
Springfield, MO 65803-1652
Phone
(417) 862-2468
Fax
(417) 863-6775
NPI assigned
Mar 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Lemmie Williams
Title
Account Manager
Phone
(417) 862-2468

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 10691 MO Primary

Addresses

Primary practice location

2105 W Kearney St
Suite a
Springfield, MO 65803-1652

Mailing address

2105 W Kearney St
Suite a
Springfield, MO 65803-1652
Phone (417) 862-2468

National Provider Directory

National Provider Directory
Tax ID family
James River Dental Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

2105 W Kearney St
Ste A
Springfield, MO 65803
Phone (417) 862-2468

NPI Registry JSON

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1538288071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 W KEARNEY ST",
            "address_2": "SUITE A",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658031652",
            "telephone_number": "417-862-2468",
            "fax_number": "417-863-6775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 W KEARNEY ST",
            "address_2": "SUITE A",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658031652",
            "telephone_number": "417-862-2468",
            "fax_number": "417-863-6775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "LEMMIE",
        "authorized_official_title_or_position": "ACCOUNT MANAGER",
        "authorized_official_telephone_number": "417-862-2468",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "10691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.