| NPI | 1093256182 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP MATTHEW MONTOYA Dentist 573-247-3040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MO 2014041731) |
| Enumeration Date | 2017-03-09 |
| Last Update Date | 2017-03-09 |