| NPI | 1730236894 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER R. BURTON Office Manager 573-446-7181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2003011293) |
| 1223P0221X Dentist Pediatric Dentistry (Licence: MO 010435) | |
| 1223X2210X Dentist Orofacial Pain | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2021-09-16 |