Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Samuel E Deatherage DMD PC

Organization General Practice Dentistry · NPI 1619040078

Samuel E Deatherage DMD PC is a General Practice Dentistry in Mountain Grove, Missouri. Registered with an NPI since 2006.

In the registry since
2006
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

920 N Main
Mountain Grove, MO 65711-1315
Phone: (417) 926-4910
Fax: (417) 926-4399
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X

Record details

NPI number1619040078
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Samuel Deatherage — President · (417) 926-4910
NPI enumeratedNovember 15, 2006
Last updated in NPPESAugust 22, 2020
Mailing address920 North Main, Mountain Grove, MO 65711-1315

Other providers in Mountain Grove