Healthcare Provider Details

I. General information

NPI: 1164788014
Provider Name (Legal Business Name): MRS. CALLIE BETH VERBIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N. PROVIDENCE RD.
COLUMBIA MO
65203-4365
US

IV. Provider business mailing address

1101 N. PROVIDENCE RD.
COLUMBIA MO
65203-4365
US

V. Phone/Fax

Practice location:
  • Phone: 573-777-8997
  • Fax:
Mailing address:
  • Phone: 573-777-8997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2013014040
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: