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1891145975
JORDAN BERRY
MACON, MO
NPI
1891145975
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
124Q00000X Dental Hygienist
(Licence: MO 2015016912)
Enumeration Date
2016-06-20
Last Update Date
2016-06-20
Business Address
-- JORDAN BERRY
209 N MISSOURI ST
MACON, MO 63552-2151
Phone number: 660-395-5045
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Mailing Address
-- JORDAN BERRY
1416 CROWN DR
KIRKSVILLE, MO 63501-2548
Phone number: 660-627-5757
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