Molly Elizabeth Tegerdine, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

2013016375 Issued in MO

Practice address

1001 W Worley St
Columbia, MO 65203-2037

Phone

(844) 853-8937

NPI assigned

Aug 13, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Compass Health, Inc

  • Community/Behavioral Health Agency
  • Clinton, MO
  • NPI 1285619494
  Medicare reassignment NPD
• Compass Health, Inc

  • Federally Qualified Health Center (FQHC)
  • Rolla, MO
  • NPI 1558258632
  NPD
• Mary K Davis DDS LLC

  • General Practice Dentistry
  • Columbia, MO
  • NPI 1710622527
  NPD (past)
• Shelley Ann Lyle DDS PC

  • Dentist
  • Columbia, MO
  • NPI 1497921423
  NPD (past)

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

{
    "created_epoch": "1376352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663027200000",
    "number": "1780017889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 COMMUNITY",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647358804",
            "telephone_number": "660-885-8131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 W WORLEY ST",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652032037",
            "telephone_number": "844-853-8937"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "303 N Keene St Ste 202",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "MO",
            "postal_code": "652018052",
            "country_code": "US",
            "telephone_number": "844-853-8937",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "307 N Broadway",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "MO",
            "postal_code": "652811407",
            "country_code": "US",
            "telephone_number": "844-853-8937",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1600 N Missouri Ave",
            "address_purpose": "LOCATION",
            "city": "Marceline",
            "state": "MO",
            "postal_code": "646581012",
            "country_code": "US",
            "telephone_number": "844-853-8937",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2475 Broadway Bluffs Dr",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "MO",
            "postal_code": "652018148",
            "country_code": "US",
            "telephone_number": "844-853-8937",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1101 N Providence Rd",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "MO",
            "postal_code": "652034365",
            "country_code": "US",
            "telephone_number": "844-853-8937",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TEGERDINE",
        "first_name": "MOLLY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-13",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2013016375",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2013016375",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "400042605",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Trisha Alane Taylor, MD
• TB Anesthesia Associates, LLC
• Vladislav Velizarov Tchatalbachev, M.D.
• Patsharaporn Techasintana, M.D.
• Colin Tegerdine, D.D.S
• Alemayehu Molla Tekalign, MD
• Barbara J. Tellerman, M.D.
• Jerry Templer, MD
• Joseph Temporal, RN
• Molly Tennyson, RN

• Dentist in Columbia, MO
• Providers in Columbia, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.