| NPI | 1629237615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRANT WENDELL WEATHERS President 573-471-5155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 14998) |
| Enumeration Date | 2008-06-04 |
| Last Update Date | 2008-06-04 |