Northside Dental L.L.C.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

2003017125 Issued in MO

Legal business name

NORTHSIDE DENTAL L.L.C.

Practice address

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

Phone

(417) 862-2468

Fax

(417) 863-6775

NPI assigned

Oct 7, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Derek Kaelin, DDS, D.D.S

Title

Owner/Dentist

Phone

(417) 862-2468

Specialties & licenses 1

Addresses

Other names 1

• Northside Dental Clinic Doing business as

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

{
    "created_epoch": "1412640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412640000000",
    "number": "1922401793",
    "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 L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-07",
        "last_updated": "2014-10-07",
        "status": "A",
        "authorized_official_last_name": "DDS",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "KAELIN,",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "417-862-2468",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MO",
            "license": "2003017125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northside Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• North Springfield Family Medical Walk in Clinics Inc
• Anthony Charles Northcote, DO
• Northern Light Therapy LLC
• Northland Hearing Centers, Inc.
• Northside Dental Clinic
• Northwind Counseling LLC
• Angela R Norton, NP
• Jenny R Norton, LMSW
• Jill Ann Norton, RNC,WHNP
• Makayla Norton

• Dental Clinic/Center in Springfield, MO
• Providers in Springfield, MO by specialty
• Dental Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2014; 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.