Newly enumerated
The official enumeration date falls within the documented new-enumeration window.
- Enumeration date is 45 days before observation
Type 2 organization · NPI 1417881244
CLEAR CREEK FAMILY DENTAL - MT. VERNON LLC
1223G0001X · MOUNT VERNON, MO
Why this profile is appearing now
Observed change signals
Reported classification
Taxonomies
| Code | Description | Source flag |
|---|---|---|
| 1223G0001X | 1223G0001X | Primary |
Taxonomy reporting does not establish licensure, board certification, expertise, or quality.
Longitudinal record
Observed change timeline
- 0 recorded field change s