| NPI | 1164033122 |
|---|---|
| Doing Business As | DENTAL DEPOT OF BLUE SPRINGS PLLC |
| Entity Type | Organization |
| Authorized Contact | GAYLON ZISSA Professional Relations Manager 405-945-8941 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2020-08-13 |
| Last Update Date | 2021-06-25 |