Healthcare Provider Details

I. General information

NPI: 1568650885
Provider Name (Legal Business Name): DEXTER SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 BROWN PILOT LN
DEXTER MO
63841-1803
US

IV. Provider business mailing address

1031 BROWN PILOT LN
DEXTER MO
63841-1803
US

V. Phone/Fax

Practice location:
  • Phone: 573-614-1000
  • Fax: 573-614-1002
Mailing address:
  • Phone: 573-614-1000
  • Fax: 573-614-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number StateMO

VIII. Authorized Official

Name: MS. KIM LIESEL PIERCE
Title or Position: PAYROLL, MEDICAID CLERK
Credential:
Phone: 573-614-1000