| NPI | 1063596088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL WAYNE BERRY Dentist Owner 660-263-1133 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MO 014845) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2020-08-22 |