| Samuel E Deatherage DMD PC | |
|
920 North Main Mountain Grove MO 65711-1315 | |
| (417) 926-4910 | |
| (417) 926-4399 |
| Full Name | Samuel E Deatherage DMD PC |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 920 North Main, Mountain Grove, Missouri |
| Authorized Official Name and Position | Samuel E Deatherage (PRESIDENT) |
| Authorized Official Contact | 4179264910 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Samuel E Deatherage DMD PC 920 North Main Mountain Grove MO 65711-1315 Ph: (417) 926-4910 | Samuel E Deatherage DMD PC 920 North Main Mountain Grove MO 65711-1315 Ph: (417) 926-4910 |
| NPI Number | 1619040078 |
|---|---|
| Provider Enumeration Date | 11/15/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619040078 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | () | Primary |
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