Neosho Kids Dental, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

NEOSHO KIDS DENTAL, LLC

Doing business as

Neosho Kids Dental

Practice address

3201 Lusk Dr Ste 111K
Neosho, MO 64850-2019

Phone

(918) 998-0996

NPI assigned

Jan 7, 2025

Organization subpart

No

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

Authorized official

Name

Creed Cardon

Title

Owner/Dentist

Phone

(918) 998-0996

Specialties & licenses 1

Addresses

Other names 1

• Neosho Kids Dental Doing business as

Locations

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

{
    "created_epoch": "1736208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736208000000",
    "number": "1851101422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 RIVERWALK TER STE 250",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740375619",
            "telephone_number": "918-998-0996",
            "fax_number": "918-235-9079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 LUSK DR STE 111K",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "648502019",
            "telephone_number": "918-998-0996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEOSHO KIDS DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-07",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A",
        "authorized_official_last_name": "CARDON",
        "authorized_official_first_name": "CREED",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "918-998-0996"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Neosho Kids Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Destinee Mullinix, PTA
• Emily Lynn Murphy, ARNP
• Preston L Myers, NP-C
• Neosho Bone & Joint Clinic P.C.
• Neosho Bone & Joint Clinic P.C.
• Neosho Optical Inc
• Neosho Powersports, Inc.
• Neosho R-V School District
• Neosho Residential, LLC
• New Visions Group Homes, Inc

• Pediatric Dentistry in Neosho, MO
• Providers in Neosho, MO by specialty
• Pediatric Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2025; 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.