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General NPI Number Information
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NPI Number | 1740275593
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Entity Type | Individual
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Provider Name | DANIEL M AUTRY D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 02/25/2015
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Provider Practice Location Address
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Address Line | 8141 JOHN MCKEEVER RD
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City | HOUSE SPRINGS
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State | MO
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Zip | 63051-3216
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Country | US
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Telephone | 618-967-9570
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Fax |
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Provider Business Mailing Address
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Address Line | 8141 JOHN MCKEEVER RD
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City | HOUSE SPRINGS
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State | MO
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Zip | 63051-3216
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Country | US
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Telephone | 618-967-9570
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 8613
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2005019770
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License Number State | MO
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