| NPI | 1952505562 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE STEWART DAVIS Owner 573-636-6220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MO DE014989) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2007-10-31 |