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Deactivated NPI 1649403197 Deactivated / Inactive NPI Male Practitioner

Dr. Roscoe Sidney Eatherly , DDS

Dentist - General Practice • Anderson, MO

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Roscoe Eatherly has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date September 01, 2009
NPI Deactivation Date May 24, 2023
Total Practice Duration ~14 Years of Practice (2009 – 2023)

Professional Overview & Biography Verified Profile Summary

Dr. Roscoe Eatherly, DDS was a registered Dentist - General Practice practicing in Anderson, MO. Throughout an active medical career spanning 14 years, Dr. Eatherly provided care at the practice location at 508 W HIGHWAY 76 until profile deactivation on 2023-05-24.

Practice Location & Contact Primary Location

Practice Address

508 W Highway 76

Anderson, MO 648318548

Telephone 4178452243
Fax 4178452533
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Anderson, MO

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 9.5 Yrs
Regional Practice Density
1 Specialists

Practicing in Anderson, MO (2113 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License MO 011347

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

5 Associated Practitioners
Kimberly George , RDH

Dental Assistant

NPI 1205161726

Registered Dental Hygienist

Dr. Avoyn Forga , DDS

Dentist - Dental Public Health

NPI 1336279470

Doctor of Dental Surgery

Amy Hill , RDH

Dental Hygienist

NPI 1427383876

Registered Dental Hygienist

Heather Mackey , RDH

Dental Assistant

NPI 1487989356

Registered Dental Hygienist

Camille Hatcher , RDH

Dental Hygienist

NPI 1720240500

Registered Dental Hygienist

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated May 24, 2023

Record deactivated on May 24, 2023

NPI Profile Active September 01, 2009

NPI status registered as active in NPPES database

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Updated Practice Location September 01, 2009

Registered at 508 W HIGHWAY 76, ANDERSON, MO 648318548 (Tel: 4178452243)

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Updated Business Mailing Address September 01, 2009

Registered at 508 W HIGHWAY 76, P.O. BOX 4343, ANDERSON, MO 648318548 (Tel: 4178452243)

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Provider Name / Credentials Updated September 01, 2009

Recorded as ROSCOE EATHERLY, D.D.S.

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Medical Taxonomy / Specialty Registered (Primary Specialty) September 01, 2009

Dentist (License #011347 in MO)

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Initial NPI Registration & Enumeration September 01, 2009

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1649403197
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 01, 2009
Last Update: September 01, 2009
Deactivation Date: May 24, 2023

Mailing Address

508 W Highway 76, P.o. Box 4343

Anderson, MO 648318548

Phone: 4178452243

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.