Healthcare Provider Details

I. General information

NPI: 1093635757
Provider Name (Legal Business Name): ANNE KESLINE JEAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W AUSTIN BLVD
NEVADA MO
64772-3124
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 844-853-8937
  • Fax: 660-890-8116
Mailing address:
  • Phone: 844-853-8937
  • Fax: 660-890-8116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2026033984
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: