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181 N Kentucky Ave Ste 300 West Plains MO 65775-2092 | |
| (417) 256-5100 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 181 N Kentucky Ave Ste 300, West Plains, Missouri |
| Authorized Official Name and Position | Shaneque S Philmon (CREDENTIALING MANAGER) |
| Authorized Official Contact | 5014622062 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 3450 Little Rock AR 72203-3450 Ph: (501) 781-2777 | 181 N Kentucky Ave Ste 300 West Plains MO 65775-2092 Ph: (417) 256-5100 |
| NPI Number | 1972014504 |
|---|---|
| Provider Enumeration Date | 10/23/2017 |
| Last Update Date | 07/30/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972014504 | NPI | - | NPPES |
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