| NPI | 1497206049 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN L HENNINGSEN President/Owner 573-635-4852 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MO 013482) |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2016-10-19 |