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General NPI Number Information
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NPI Number | 1649136003
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Entity Type | Organization
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Legal Business Name | NORTHSIDE FAMILY DENTISTRY, LLC
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Dates
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Enumeration Date | 12/30/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 5898 N MAIN ST STE 109
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City | JOPLIN
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State | MO
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Zip | 64801-9103
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Country | US
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Telephone | 417-208-9842
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Fax | 417-208-9843
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Provider Business Mailing Address
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Address Line | 5898 N MAIN ST STE 109
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City | JOPLIN
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State | MO
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Zip | 64801-9103
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Country | US
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Telephone | 417-208-9842
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Fax | 417-208-9843
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. ANDREW BYRNE
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Credential | DDS
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Telephone | 417-758-9665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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