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Organization

SOUTHEAST MISSOURI HEALTH NETWORK

Active
Other names
BERNIE DENTAL Clinic
Organization subpart
No

Provider details

NPI number
Authorized official
MS. SARA DEANE (CHIEF FINANCIAL OFFICER)
(573) 313-2500
Entity
Organization

Contact information

Practice address
741 S WALNUT ST, BERNIE, MO 63822-8900
(573) 293-6930
(573) 293-6841
Mailing address
741 SOUTH WALNUT, BERNIE, MO 63822
(573) 293-6930
(573) 293-6841

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
261QF0400X
Federally Qualified Health Center (FQHC)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1598069247
MO
Enumeration date
01/10/2011
Last updated
03/22/2021
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