| NPI | 1770788903 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER WILSON Office Manager 573-335-6709 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO D015383) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2020-08-22 |