Organization
DEREK R. KAELIN, D.D.S, LLC
Active
Other names
Northside Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEREK R KAELIN DDS (DENTIST / OWNER)
(417) 862-2468
Entity
Organization
Contact information
Practice address
2105 W KEARNEY ST STE A, SPRINGFIELD, MO 65803-1666
(417) 862-2468
(417) 863-6775
Mailing address
2105 W KEARNEY ST STE A, SPRINGFIELD, MO 65803-1666
(417) 862-2468
(417) 863-6775
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
2003017125
MO
Other
Enumeration date
01/21/2011
Last updated
01/21/2011
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