Organization
HANNIBAL DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VICKI L LUEBRECHT (OFFICE MANAGER)
(573) 221-1227
Entity
Organization
Contact information
Practice address
2727 SAINT MARYS AVE, HANNIBAL, MO 63401-3774
(573) 221-1227
(573) 221-5564
Mailing address
2727 SAINT MARYS AVE, HANNIBAL, MO 63401-3774
(573) 221-1227
(573) 221-5564
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9881
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
409534
INSURANCE
MO
01
—
409535
INSURANCE
MO
01
—
501065
INSURANCE
MO
01
—
501160
INSURANCE
MO
01
—
501174
INSURANCE
MO
01
—
74007199
INSURANCE
MO
01
—
74014433
INSURANCE
MO
01
—
74014632
INSURANCE
MO
01
—
74017142
INSURANCE
MO
01
—
818028
INSURANCE
MO
01
—
M00100
INSURANCE
MO
Enumeration date
01/26/2006
Last updated
08/22/2020
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