Organization Name: | DEERE DENTISTRY |
NPI Number: | 1912314378 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHEILAH K DEERE (OWNER/OFFICE MANAGER) |
Mailing Address: | 205 E 4th St Portageville |
State: | MO US |
Postal Code: | 638731464 |
Phone Number: | 5733795407 |
Fax Number: | 5733795407 |
NPI Enumeration Date: | 07/17/2014 |
NPI Last Update Date: | 07/17/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |