| NPI | 1689642308 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELVINA TUCKER Office Manager 417-882-0948 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2022-04-13 |