| NPI | 1063676369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD WILLIAM LAKE President 573-438-6277 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MO 11627) |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2008-07-16 |