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General NPI Number Information
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NPI Number | 1871802447
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Entity Type | Organization
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Legal Business Name | STEPHEN M CARRON DDS LLC
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Dates
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Enumeration Date | 09/30/2010
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Last Update Date | 09/30/2010
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Provider Practice Location Address
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Address Line | 12 S JACKSON ST STE 3
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City | PERRYVILLE
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State | MO
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Zip | 63775-2535
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Country | US
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Telephone | 573-547-5570
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Fax |
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Provider Business Mailing Address
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Address Line | 12 S JACKSON ST STE 3
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City | PERRYVILLE
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State | MO
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Zip | 63775-2535
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Country | US
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Telephone | 573-547-5570
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHEN M CARRON
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Credential | DDS
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Telephone | 573-547-5570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 013945
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License Number State | MO
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