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FREDERICKTOWN FAMILY DENTAL
NPI 1043689557
Dentist - General Practice in Fredericktown, MO

Active since September 15, 2015
731 W MAIN ST, FREDERICKTOWN, MO 63645(573) 783-4100 Get Directions Write a Review

NPPES record last updated: September 16, 2015. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Fredericktown Family Dental NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FREDERICKTOWN FAMILY DENTAL (NPI 1043689557) is a healthcare organization registered as a general practice in Fredericktown, Missouri and active in the NPI registry since September 2015. The organization lists John Adams, Owner, as its authorized official.

NPPES Registry Identity

NPI1043689557
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameFREDERICKTOWN FAMILY DENTAL
Location Address731 W MAIN STFredericktown, MO 63645-1113
Mailing Address731 W Main StFredericktown, MO 63645-1113 · (573) 783-4100
Phone(573) 783-4100
Organization SubpartNo
Authorized OfficialJohn AdamsOwner · (573) 783-4100
Enumeration DateSeptember 15, 2015
Last NPPES UpdateSeptember 16, 2015
✔ NPI 1043689557 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

731 W MAIN ST, Fredericktown, MO 63645
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 26D2205953

Fredericktown Ebo MD LLC · Fredericktown, MO
Active · expires Dec 15, 2026
CLIA Number26D2205953
Laboratory TypePhysician Office
Certificate Effective DateDecember 16, 2024
Certificate Expiration DateDecember 15, 2026
Laboratory DirectorMelissa Y. Jordan
Laboratory Phone(573) 561-5051
Laboratory LocationFredericktown Ebo MD LLC605 Lincoln Dr, Fredericktown, MO 63645
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. LINDA CAROLE CRAVENS RDN
Dentist
731 W MAIN ST, GUY A WALKER DDS
FREDERICKTOWN, MO 63645
Madison County (573) 783-4100
MR. JOHN S. ADAMS D.D.S.
Dentist (General Practice)
731 W MAIN ST
FREDERICKTOWN, MO 63645
Madison County (573) 783-4100

Frequently Asked Questions

What is FREDERICKTOWN FAMILY DENTAL's NPI number?

The NPI number assigned to this healthcare provider is 1043689557, enumerated as an "organization" on September 15, 2015.

Where is the provider located?

The provider is located at 731 W MAIN ST FREDERICKTOWN, MO 63645 and the phone number is (573) 783-4100.

What is the provider's specialty?

Dentist with taxonomy code 1223G0001X and a focus in General Practice.