| NPI | 1992984173 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN C. WALLER Dentist 573-756-4344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 1999135982) |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2009-01-22 |