Organization
SOUTHEAST MISSOURI HEALTH NETWORK
Active
Other names
otto bean dental clinic
Organization subpart
No
Provider details
NPI number
Authorized official
CHRIS JONES (CHIEF EXECUTIVE OFFICER)
(573) 748-2404
Entity
Organization
Contact information
Practice address
500 RUSSELL ST, KENNETT, MO 63857-2102
(573) 888-3000
(573) 888-3003
Mailing address
420 SEMO DR, P.O. BOX 400, NEW MADRID, MO 63869-1734
(573) 748-2404
(573) 748-8929
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013229749
—
MO
Enumeration date
07/10/2010
Last updated
08/06/2014
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