Carthage Dental Associates LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

CARTHAGE DENTAL ASSOCIATES LLC

Practice address

626 W Centennial Ave
Carthage, MO 64836-2846

Phone

(417) 358-9006

NPI assigned

Nov 20, 2024

Last updated

Nov 20, 2024By 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

Katrina M Wicklund, DDSNPI 1710337423

Title

Dentist

Phone

(417) 358-9006

Specialties & licenses 1

Addresses

Locations

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.

• Katrina M Wicklund, DDS

  • Dentist
  • Carthage, MO
  • NPI 1710337423
  NPD Authorized official

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

{
    "created_epoch": "1732060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732060800000",
    "number": "1730904186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "626 W CENTENNIAL AVE",
            "city": "CARTHAGE",
            "state": "MO",
            "postal_code": "648362846",
            "telephone_number": "417-358-9006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "626 W CENTENNIAL AVE",
            "city": "CARTHAGE",
            "state": "MO",
            "postal_code": "648362846",
            "telephone_number": "417-358-9006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARTHAGE DENTAL ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-20",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A",
        "authorized_official_last_name": "WICKLUND",
        "authorized_official_first_name": "KATRINA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "417-358-9006",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Campbell, FNP-C
• Carthage Anesthesia Inc
• Carthage Children's Clinic, LLC
• Carthage Counseling
• Carthage Counseling LLC
• Carthage Emergency Physicians LLC
• Carthage Eye Care PC
• Carthage Family Dental LLC
• Carthage Pediatric Dentistry, P LLC (Carthage Pediatric Dental)
• Carthage R-9 School District

• General Practice Dentistry in Carthage, MO
• Providers in Carthage, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 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.