| NPI | 1508549130 |
|---|---|
| Doing Business As | TBD |
| Entity Type | Organization |
| Authorized Contact | KYLE LISENBY Dentist Owner 573-424-2067 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2023-08-10 |
| Last Update Date | 2023-08-10 |