| NPI | 1093939811 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD E. HICKS President 660-826-8844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 013691) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2020-08-22 |