| NPI | 1437558137 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE NATHANIEL GARDNER Owner 417-719-7862 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2012019137) |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2020-05-28 |