| NPI | 1184483216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE MELANSON Owner 417-289-0000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2024-03-19 |
| Last Update Date | 2024-03-19 |