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General NPI Number Information
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NPI Number | 1205554144
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Entity Type | Organization
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Legal Business Name | KNOB NOSTER FAMILY DENTAL
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Dates
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Enumeration Date | 08/17/2022
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 204 N ADAMS AVE
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City | KNOB NOSTER
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State | MO
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Zip | 65336-1304
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Country | US
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Telephone | 660-563-5633
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Fax |
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Provider Business Mailing Address
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Address Line | 204 N ADAMS AVE
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City | KNOB NOSTER
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State | MO
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Zip | 65336-1304
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | INSURANCE SPECIALIST
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Name | STACIA WEDDLE
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Credential |
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Telephone | 816-769-6119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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