| NPI | 1922435148 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL CHASE KELLY Dentist 417-881-1213 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: MO 2013017374) |
| Enumeration Date | 2013-10-02 |
| Last Update Date | 2013-10-02 |