| Dr. Stephen C. Waller, Dds, Llc | |
|
115 Walnut St Ellington MO 63638 | |
| (573) 756-4344 | |
| (573) 756-4699 |
| Full Name | Dr. Stephen C. Waller, Dds, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 115 Walnut St, Ellington, Missouri |
| Authorized Official Name and Position | Stephen C. Waller (DENTIST) |
| Authorized Official Contact | 5737564344 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Stephen C. Waller, Dds, Llc Po Box 157 110 S. 2nd St Ellington MO 63638-0157 Ph: (573) 663-2313 | Dr. Stephen C. Waller, Dds, Llc 115 Walnut St Ellington MO 63638 Ph: (573) 756-4344 |
| NPI Number | 1992984173 |
|---|---|
| Provider Enumeration Date | 10/24/2007 |
| Last Update Date | 01/22/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992984173 | NPI | - | NPPES |
| 1578574240 | Other | MO | TYPE 1 NPI NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 1999135982 (Missouri) | Primary |