| NPI | 1730369943 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARREN WILLIAM MAHAFFEY Member 417-887-3573 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 11799) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2005015640) |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2007-11-06 |