| NPI | 1578819702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA R TILMAN Office Manager 660-826-5860 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2012018223) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2012-07-25 |