| NPI | 1104987841 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES LEE SAMPLES Owner 660-542-1653 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 11650) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2020-08-22 |