CMS-1500 Box 24J / 33a • NPI
1730236894
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
1223S0112X (CMS 19)
Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)
Box 32 Service Location & ZIP+4
1401 FORUM BLVD, STE. 203, COLUMBIA, MO, 65203-1915
✓ 9-Digit EDI 837 ZIP+4 (65203-1915)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1730236894 (ACCENT DENTAL CENTER ON FORUM, LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1730236894 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | ACCENT DENTAL CENTER ON FORUM, LLC |
| Plain-English Specialty | Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) NUCC Code: 1223S0112X (Dentist, Oral and Maxillofacial Surgery) |
| Certifying / Licensing Body | American Dental Association (ADA) / State Board of Dental Examiners |
| Practice Location Address | 1401 FORUM BLVD, STE. 203, COLUMBIA, MO, 65203-1915 |
| Practice Telephone / Fax | Tel: (573) 446-7181 | Fax: (573) 446-1770 |
| Administrative Mailing Address | 1401 FORUM BLVD, COLUMBIA, MO, 65203-1915 |
| Enumeration & Last Sync | Enumerated: 2007-01-04 | CMS Record Updated: 2021-09-16 |
| Authorized Official | HEATHER BURTON (Office Manager) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (1223S0112X)
What Does Taxonomy Code 1223S0112X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 1223S0112X translates to:
"Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (ACCENT DENTAL CENTER ON FORUM, LLC)
Typical CPT / Diagnostic Procedures:- Comprehensive Oral Evaluation, Digital Dental Radiographs & Prophylaxis
- Restorative Composite Fillings, Crowns, Endodontic Root Canal & Extractions
- Amoxicillin, Metronidazole & Clindamycin (Odontogenic Infections)
- Chlorhexidine Gluconate 0.12% Oral Rinse & High-Fluoride Varnish
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
122300000X — DentistPlain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) | State: MO | License: 2003011293 | Primary: Secondary |
1223P0221X — Dentist, Pediatric DentistryPlain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) | State: MO | License: 010435 | Primary: Secondary |
1223X2210X — Dentist, Orofacial PainPlain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) | State: N/A | License: Verified | Primary: Secondary |
332B00000X — Durable Medical Equipment & Medical SuppliesPlain English: Licensed & Credentialed Suppliers — Durable Medical Equipment & Medical Supplies | State: N/A | License: Verified | Primary: Secondary |
1223S0112X — Dentist, Oral and Maxillofacial SurgeryPlain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) | State: N/A | License: Verified | Primary: Yes (Primary) |
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