NORTHSIDE DENTAL CLINIC
NPI 1922401793
Clinic/Center - Dental in Springfield, MO

Active since October 07, 2014
2105 W KEARNEY ST, SUITE A, SPRINGFIELD, MO 65803(417) 862-2468(417) 863-6775 Get Directions Write a Review

NPPES record last updated: October 7, 2014. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Northside Dental Clinic NPPES

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

NORTHSIDE DENTAL CLINIC (NPI 1922401793) is a healthcare organization registered as a dental in Springfield, Missouri and active in the NPI registry since October 2014. The organization lists Derek Kaelin, Dds, Owner/dentist, as its authorized official.

NPPES Registry Identity

NPI1922401793
Entity TypeOrganization
Primary Taxonomy261QD0000X
Legal Business NameNORTHSIDE DENTAL L.L.C.
Location Address2105 W KEARNEY ST, SUITE ASpringfield, MO 65803-1652
Mailing Address2105 W Kearney St, Suite ASpringfield, MO 65803-1652 · (417) 862-2468 · Fax (417) 863-6775
Fax(417) 863-6775
Organization SubpartNo
Authorized OfficialDerek Kaelin, DdsOwner/dentist · (417) 862-2468
Enumeration DateOctober 7, 2014
NPI 1922401793 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyClinic/Center · DentalAmbulatory Health Care Facilities
Taxonomy Code261QD0000X
License Licensed in MO · 2003017125
2105 W KEARNEY ST, Springfield, MO 65803

Other Names 1

Doing Business AsNorthside Dental Clinic

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.

Dentist (General Practice)
2105 W KEARNEY ST, SUITE A
SPRINGFIELD, MO 65803
Dentist (General Practice)
2105 W KEARNEY ST, SUITE A
SPRINGFIELD, MO 65803

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Northside Dental L.L.C.'s NPI number?

The NPI number for Northside Dental L.L.C. is 1922401793. It was assigned to this organization in the NPPES registry on October 7, 2014. The provider is doing business as Northside Dental Clinic.

Where is Northside Dental L.L.C. located?

Northside Dental L.L.C. is located at 2105 W Kearney St Suite A, Springfield, MO 65803. The listed phone number is (417) 862-2468.

What is Northside Dental L.L.C.'s specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Dental, with taxonomy code 261QD0000X.

When was this NPI record last updated?

The NPPES record for Northside Dental L.L.C. was last updated on October 7, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.