| NPI | 1700890332 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY S JACOBSON President 816-444-7787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MO 9994-216) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2020-08-22 |