NPI | 1457514259 |
---|---|
Entity Type | Organization |
Authorized Contact | MARK S LAKE Dentist 573-348-9888 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2006014707) |
Enumeration Date | 2008-07-02 |
Last Update Date | 2008-07-02 |