Full Name | |
---|---|
Speciality | Dentist - General Practice |
Location | 205 N 2nd St, Thayer, Missouri |
Authorized Official Name and Position | Samir Prakash Patel (CEO) |
Authorized Official Contact | 4172647266 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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205 N 2nd St Thayer MO 65791-1263 Ph: (417) 264-7266 | 205 N 2nd St Thayer MO 65791-1263 Ph: (417) 264-7266 |
NPI Number | 1255684577 |
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Provider Enumeration Date | 10/24/2012 |
Last Update Date | 10/24/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1255684577 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 2011010982 (Missouri) | Primary |