=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700715729
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLEAR CREEK FAMILY DENTAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2026
-----------------------------------------------------
Last Update Date | 05/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 609 E WELLS ST STE F
-----------------------------------------------------
City | ASH GROVE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65604-7374
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-751-9112
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1281 W SAGE CT
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65810-6015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-751-9112
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASSOCIATE DENTIST
-----------------------------------------------------
Name | DR. CHRISTOPHER DAVID KOLLMEYER
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 417-893-9915
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------