| NPI | 1841404019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN D WALLACE Dentist 417-881-1123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: MO 014935) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2008-08-21 |