| 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 |