CORDELL LAKE, D.D.S., LLC (NPI# 1619446077) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619446077 |
| Entity Type | Organization |
| Organization Name | CORDELL LAKE, D.D.S., LLC |
| Practice Address |
12 E Harrison St Farmington MO 63640-1859 |
| Mailing Address |
3145 Cross Creek Dr Camdenton MO 65020-9377 |
| Practice Telephone | 5737564344 |
| Mailing Telephone | 8167281630 |
| Enumeration Date | 2018-11-15 |
| Last Update Date | 2018-11-15 |
| Authorized Official Name | CORDELL LAKE (GENERAL DENTIST) |
| Authorized Official Telephone | 8167281630 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| Street Address |
12 E HARRISON ST |
| City | FARMINGTON |
| State | MO |
| Zip Code | 63640-1859 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285887448 | Timothy M. O'bryan Dds, LLC | Clinic/Center | 12 E Harrison St, Farmington, MO 63640-1859 | 2008-10-30 |
| 1255744405 | Cordell Lake | Dentist | 12 E Harrison St, Farmington, MO 63640-1859 | 2014-06-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316545254 | Brenda S Halton | Nurse Practitioner | 1010 West Columbia Street, Farmington, MO 63640 | 2020-10-13 |
| 1619519089 | Stacey Nicole Gillette | Counselor | 17885 Hart Pinkston Rd, Farmington, MO 63640 | 2019-10-17 |
| 1346890696 | Christopher Ryan Massey | Social Worker | 607 Pine St., Farmington, MO 63640 | 2019-09-18 |
| 1457909376 | Clarice Ogden | Social Worker | 203 South Washington Street, Farmington, MO 63640 | 2019-09-04 |
| 1861979718 | Clint Thebeau | In Home Supportive Care | 1276 W Liberty St, Farmington, MO 63640 | 2018-07-24 |
| 1023500600 | Lynn Machelle Knox | Counselor | 219 W Columbia St, Farmington, MO 63640 | 2018-05-31 |
| 1235620576 | Kim Bazzell | Registered Nurse | 1565 Ste. Genevieve Ave., Farmington, MO 63640 | 2018-05-22 |
| 1164919742 | Lincare Inc. | Durable Medical Equipment & Medical Supplies | 774 Market St, Farmington, MO 63640 | 2018-04-18 |
| 1184127813 | Michelle Lynette Corvallis | Chiropractor | 17 South Franklin St., Farmington, MO 63640 | 2018-03-08 |
| 1992206213 | Farmington Vision Care LLC | Optometrist | 110 E Harrison St, Farmington, MO 63640 | 2018-02-22 |
| Find all providers in zip 63640 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689159147 | Station Park Dental LLC | Clinic/Center | 1060 W Park Ln Ste 110, Farmington, UT 84025-2992 | 2018-10-01 |
| 1285887448 | Timothy M. O'bryan Dds, LLC | Clinic/Center | 12 E Harrison St, Farmington, MO 63640-1859 | 2008-10-30 |
| 1053923656 | Family Dentistry of Farmington | Clinic/Center | 24001 Orchard Lake Rd Ste 160, Farmington, MI 48336-2553 | 2020-08-17 |
| 1619514718 | Farmington Dental Pllc | Clinic/Center | 200 Mountain Rd, Farmington, CT 06032-2479 | 2019-12-08 |
| 1598193088 | Derek Graff Dmd Ltd | Clinic/Center | 3180 N Butler Ave, Bldg 200, Farmington, NM 87401-2334 | 2013-10-22 |
| 1417200932 | Compassion Dental 06032 | Clinic/Center | 222 Main St, #251, Farmington, CT 06032-3623 | 2012-10-22 |
| 1962760462 | Pdg, P.a. | Clinic/Center | 511 Elm St, Farmington, MN 55024-1126 | 2012-05-03 |
| 1679740013 | San Juan College | Clinic/Center | 4601 College Blvd, Dental Clinic, Farmington, NM 87402-4609 | 2008-05-14 |
| 1295937977 | Westmount Dental Arts | Clinic/Center | 1273 Doctors Dr, Farmington, MO 63640-2947 | 2007-06-04 |
| 1922029768 | University Dentists | Clinic/Center | 263 Farmington Ave, Mc2105, Farmington, CT 06030-0001 | 2006-07-21 |
| Find all providers in FARMINGTON | ||||
| City | FARMINGTON |
| Zip Code | 63640 |
Please comment or provide details below to improve the information on CORDELL LAKE, D.D.S., LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.