Full Name | |
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Speciality | Dentist - General Practice |
Location | 9394 Us 63, Thayer, Missouri |
Authorized Official Name and Position | Bryan Adcock (CEO) |
Authorized Official Contact | 4172642990 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1137 Independence Dr West Plains MO 65775-4221 Ph: (417) 255-8464 | 9394 Us 63 Thayer MO 65791-9448 Ph: (417) 264-2990 |
NPI Number | 1730414178 |
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Provider Enumeration Date | 10/02/2009 |
Last Update Date | 05/16/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1730414178 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |