Healthcare Provider Details

I. General information

NPI: 1255868725
Provider Name (Legal Business Name): MCCALL FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 S 24TH ST
BETHANY MO
64424-2632
US

IV. Provider business mailing address

812 S 24TH ST
BETHANY MO
64424-2632
US

V. Phone/Fax

Practice location:
  • Phone: 660-425-3331
  • Fax: 660-425-3341
Mailing address:
  • Phone: 660-425-3331
  • Fax: 660-425-3341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRUCE W MCCALL
Title or Position: DDS/OWNER
Credential:
Phone: 660-425-3331