| NPI | 1518427079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDNA ROSE LIVINGSTON Practice Manager 573-298-4400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2020-05-21 |