| NPI | 1982827465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY BURROW Operations Manager 573-638-3897 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 12095) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2020-08-22 |