Dr. Stephen C. Waller, Dds, Llc | |
115 Walnut St Ellington MO 63638 | |
(573) 756-4344 | |
(573) 756-4699 |
Full Name | Dr. Stephen C. Waller, Dds, Llc |
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Speciality | Dentist - General Practice |
Location | 115 Walnut St, Ellington, Missouri |
Authorized Official Name and Position | Stephen C. Waller (DENTIST) |
Authorized Official Contact | 5737564344 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Dr. Stephen C. Waller, Dds, Llc Po Box 157 110 S. 2nd St Ellington MO 63638-0157 Ph: (573) 663-2313 | Dr. Stephen C. Waller, Dds, Llc 115 Walnut St Ellington MO 63638 Ph: (573) 756-4344 |
NPI Number | 1992984173 |
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Provider Enumeration Date | 10/24/2007 |
Last Update Date | 01/22/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1992984173 | NPI | - | NPPES |
1578574240 | Other | MO | TYPE 1 NPI NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 1999135982 (Missouri) | Primary |