| State Fair Dental Llc | |
|
1806 W 5th St Sedalia MO 65301-2420 | |
| (972) 869-3789 | |
| Not Available |
| Full Name | State Fair Dental Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1806 W 5th St, Sedalia, Missouri |
| Authorized Official Name and Position | Faith Gaskins (DIRECTOR OF CREDENTIALING) |
| Authorized Official Contact | 6308773520 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| State Fair Dental Llc 1806 W 5th St Sedalia MO 65301-2420 Ph: (972) 869-3789 | State Fair Dental Llc 1806 W 5th St Sedalia MO 65301-2420 Ph: (972) 869-3789 |
| NPI Number | 1326644600 |
|---|---|
| Provider Enumeration Date | 12/10/2020 |
| Last Update Date | 12/10/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326644600 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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