Clear Creek Family Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2009013248 Issued in MO

Legal business name

CLEAR CREEK FAMILY DENTAL

Practice address

609 E Wells St Ste F
Ash Grove, MO 65604-9087

Phone

(417) 751-9112

NPI assigned

Mar 2, 2010

Last updated

Mar 2, 2010By 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

Dr. Joshua Tanner Rust, DDS

Title

President/Owner

Phone

(417) 751-9112

Specialties & licenses 1

Addresses

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.

• Samuel Reed Zimmer, DDS

  • Dentist
  • Ash Grove, MO
  • NPI 1245722479
  NPD (past)

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

{
    "created_epoch": "1267488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267488000000",
    "number": "1962725184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 E WELLS ST STE F",
            "city": "ASH GROVE",
            "state": "MO",
            "postal_code": "656049087",
            "telephone_number": "417-751-9112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 E WELLS ST STE F",
            "city": "ASH GROVE",
            "state": "MO",
            "postal_code": "656049087",
            "telephone_number": "417-751-9112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEAR CREEK FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-02",
        "last_updated": "2010-03-02",
        "status": "A",
        "authorized_official_last_name": "RUST",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "TANNER",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "417-751-9112",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2009013248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katrina Rochelle Chambers, LMT, MMP
• Citizens Memorial Health Care Foundation (Ash Grove Healthcare Facility)
• Citizens Memorial Health Care Foundation
• Citizens Memorial Healthcare (Ash Grove Family Medical Center)
• Clear Creek Family Dental
• Jennifer J Collier, LCSW
• Roy Crocker
• Dragon Fly Counseling, LLC
• Fincare , Inc. (Ash Grove Community Mental Health Center)
• Traci French, MD, MBA

• General Practice Dentistry in Ash Grove, MO
• Providers in Ash Grove, 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 Mar 2, 2010; 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.