| NPI | 1164645438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOGAN H CHILDERS Owner 816-478-4202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 011990) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 010648) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2020-08-22 |