Healthcare Provider Details

I. General information

NPI: 1265029797
Provider Name (Legal Business Name): VERNON DENTAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E 9TH ST
ELDON MO
65026-1605
US

IV. Provider business mailing address

102 E 9TH ST
ELDON MO
65026-1605
US

V. Phone/Fax

Practice location:
  • Phone: 573-392-3886
  • Fax: 573-392-5867
Mailing address:
  • Phone: 573-392-3886
  • Fax:

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. CAITLYN VERNON
Title or Position: DENTIST
Credential: DDS
Phone: 573-392-3886