Lori Adell, DDS
Individual provider Active NPI Dentist · Sikeston, MO
NPI 1992716229 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1992716229
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2005016963 (MO)
- Practice address
- 903 S Kingshighway St
Sikeston, MO 63801-4415 - Phone
- (573) 471-4167
- Fax
- (573) 472-4050
- NPI assigned
- Aug 11, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150529002191 | MO | Order and Referring Only - Dentist |
3870814072 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeast Missouri Health Network | Past | Accepting new patients | |
| Southeast Missouri Health Network | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2005016963 | MO | Yes |
Addresses
Primary practice location
903 S Kingshighway St
Sikeston, MO 63801-4415
Mailing address
PO Box 400
New Madrid, MO 63869-0400
Phone (573) 748-2404
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 406087205 | Medicaid | MO |
Other providers in Sikeston, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.