| NPI | 1982800850 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID LAWRENCE DETAR Owner 417-781-8240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MO 12028) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2020-08-22 |