NPI | 1972040699 |
---|---|
Doing Business As | GRAIN VALLEY FAMILY DENTAL |
Entity Type | Organization |
Authorized Contact | PETER BENJAMIN MCCLELLAN Owner Dentist 573-230-6862 |
Organization Subpart ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MO 2010016286) |
Enumeration Date | 2017-01-20 |
Last Update Date | 2017-01-20 |