| NPI | 1164755237 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL LEE MINTEN Owner/Dentist 573-443-5195 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 014811) |
| Enumeration Date | 2009-09-08 |
| Last Update Date | 2009-09-08 |