| NPI | 1427366566 |
|---|---|
| Doing Business As | KATY TRAIL - DENTAL - SEDALIA |
| Entity Type | Organization |
| Authorized Contact | MICHAEL WALLER CEO 660-826-4774 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2010-09-23 |
| Last Update Date | 2024-02-21 |