Samuel E Deatherage DMD PC

General Practice Dentistry · Mountain Grove, MO

Organization Active NPI

NPI number 1619040078

Practice location

920 North Main
Mountain Grove, MO 65711-1315
Phone
(417) 926-4910
Fax
(417) 926-4399

Open in Google Maps

NPI record

NPI
1619040078
Entity type
Organization (Type 2)
Enumeration date
November 15, 2006
Last updated
August 22, 2020
Organization subpart
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
General Practice Dentistry Primary 1223G0001X — —

Authorized official

Name
Samuel E Deatherage, DMD
Title
President
Phone
(417) 926-4910

About Samuel E Deatherage DMD PC

Samuel E Deatherage DMD PC is a healthcare organization registered in the NPI registry with the primary taxonomy General Practice Dentistry (code 1223G0001X). The practice location is 920 North Main, Mountain Grove, MO 65711-1315. The NPI number 1619040078 was assigned on November 15, 2006 and the record was last updated on August 22, 2020.

The authorized official for this organization is Samuel E Deatherage, DMD, President.

Frequently asked questions

What is the NPI number of Samuel E Deatherage DMD PC?

The NPI number is 1619040078.

What is the phone number of Samuel E Deatherage DMD PC?

The phone number listed for the practice location is (417) 926-4910.

Where is Samuel E Deatherage DMD PC located?

920 North Main, Mountain Grove, MO 65711-1315.

What is the taxonomy code for Samuel E Deatherage DMD PC?

The primary taxonomy code is 1223G0001X – General Practice Dentistry.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

Other General Practice Dentistry providers in Mountain Grove

All General Practice Dentistry providers in Mountain Grove, MO →