OrganizationActive
Samuel E Deatherage DMD PC
NPI 1619040078 · General Practice Dentistry · Mountain Grove, MO
Samuel E Deatherage DMD PC is a General Practice Dentistry organization in Mountain Grove, MO (NPI 1619040078).
Provider details
- NPI number
- 1619040078
- Entity type
- Organization
- Primary specialty
- General Practice DentistryDental Providers
- Organization subpart
- No
- Authorized official
- Samuel Deatherage, President(417) 926-4910
Specialties & taxonomies
Dental Providers
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
920 North Main
Mountain Grove, MO 65711-1315
Phone: (417) 926-4910
Fax: (417) 926-4399
Approximate (ZIP-level) locationGet directions
Mailing address
920 North Main
Mountain Grove, MO 65711-1315
Registry dates
- Enumerated
- 2006-11-15
- Last updated
- 2020-08-22
Frequently asked questions
- What is Samuel E Deatherage DMD PC's NPI number?
- Samuel E Deatherage DMD PC's National Provider Identifier (NPI) is 1619040078, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Samuel E Deatherage DMD PC?
- Samuel E Deatherage DMD PC is classified in the NPPES registry as General Practice Dentistry (Dental Providers).
- Where is Samuel E Deatherage DMD PC located?
- Samuel E Deatherage DMD PC's practice location on file with NPPES is 920 North Main, Mountain Grove, MO 65711-1315.
- What is Samuel E Deatherage DMD PC's phone number?
- The practice phone number listed in the NPPES registry for Samuel E Deatherage DMD PC is (417) 926-4910.
- Who is the authorized official for Samuel E Deatherage DMD PC?
- The authorized official listed on Samuel E Deatherage DMD PC's NPPES record is Samuel Deatherage, President. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Samuel E Deatherage DMD PC's NPI active?
- Yes — Samuel E Deatherage DMD PC's NPI (1619040078) is active in the NPPES registry as of the last update on 2020-08-22.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.