Healthcare Provider Details

I. General information

NPI: 1700715729
Provider Name (Legal Business Name): CLEAR CREEK FAMILY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 E WELLS ST STE F
ASH GROVE MO
65604-7374
US

IV. Provider business mailing address

1281 W SAGE CT
SPRINGFIELD MO
65810-6015
US

V. Phone/Fax

Practice location:
  • Phone: 417-751-9112
  • Fax:
Mailing address:
  • Phone: 417-751-9112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER DAVID KOLLMEYER
Title or Position: ASSOCIATE DENTIST
Credential: DMD
Phone: 417-893-9915