| NPI | 1942751086 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY VIRGINIA GADBOIS Owner/Dentist 573-446-0880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2000158124) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: MO 2000158124) |
| Enumeration Date | 2016-10-24 |
| Last Update Date | 2024-09-03 |