| NPI | 1982765426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDAL LEE HILLIS Owner,Dentist 573-785-6699 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 14340) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2020-08-22 |