NPIMap

Organization Active NPI

Lake Dental Clinic LLC

  • General Practice Dentistry
  • Camdenton, MO
National Provider Identifier
1720141849
Registry record updated Apr 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
LAKE DENTAL CLINIC LLC
Practice address
1497 N State Highway 5
Camdenton, MO 65020
Phone
(573) 346-7278
Fax
(573) 346-2176
NPI assigned
Dec 19, 2006
Last updated
Apr 24, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2008

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

Authorized official

Name
Vernon Dale McElwee, DDS
Title
Owner
Phone
(573) 346-7278

Specialties & licenses 1

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

Addresses

Primary practice location

1497 N State Highway 5
Camdenton, MO 65020

Mailing address

PO Box 820
Camdenton, MO 65020
Phone (573) 346-7278

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208995200000",
    "number": "1720141849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 820",
            "city": "CAMDENTON",
            "state": "MO",
            "postal_code": "65020",
            "telephone_number": "573-346-7278",
            "fax_number": "573-346-2176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1497 N STATE HIGHWAY 5",
            "city": "CAMDENTON",
            "state": "MO",
            "postal_code": "65020",
            "telephone_number": "573-346-7278",
            "fax_number": "573-346-2176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE DENTAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2008-04-24",
        "status": "A",
        "authorized_official_last_name": "MCELWEE",
        "authorized_official_first_name": "VERNON",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-346-7278",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Camdenton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2008; 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.