| NPI | 1124322581 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRANCIS J. OTRADOVEC President 573-443-0593 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MO 011967) |
| Enumeration Date | 2010-12-28 |
| Last Update Date | 2010-12-28 |