| NPI | 1114631439 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY M SPENCE Owner/Provider 573-450-1141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-01-11 |
| Last Update Date | 2023-01-11 |