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General NPI Number Information
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NPI Number | 1295116234
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Entity Type | Organization
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Legal Business Name | CORNERSTONE ENDODONTICS MISSOURI LLC
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Dates
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Enumeration Date | 06/16/2015
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Last Update Date | 06/16/2015
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Provider Practice Location Address
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Address Line | 1218 NE WINDSOR DR
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City | LEES SUMMIT
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State | MO
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Zip | 64086-5594
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Country | US
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Telephone | 816-554-7668
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Fax |
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Provider Business Mailing Address
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Address Line | 1218 NE WINDSOR DR
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City | LEES SUMMIT
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State | MO
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Zip | 64086-5594
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Country | US
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Telephone | 816-554-7668
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | OLIVIA MULL
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Credential |
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Telephone | 913-498-3636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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