| NPI | 1295030203 |
|---|---|
| Doing Business As | NORTHSIDE DENTAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | DEREK R KAELIN Dentist / Owner 417-862-2468 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MO 2003017125) |
| Enumeration Date | 2011-01-21 |
| Last Update Date | 2011-01-21 |