| Tailwater Practice Partners | |
|
1701 E 10th St Rolla MO 65401-4601 | |
| (573) 364-1599 | |
| Not Available |
| Full Name | Tailwater Practice Partners |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1701 E 10th St, Rolla, Missouri |
| Authorized Official Name and Position | Ryan Mccostlin (CEO) |
| Authorized Official Contact | 6154792196 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tailwater Practice Partners 10 Burton Hills Blvd Ste 400 Nashville TN 37215-3004 Ph: (615) 479-2196 | Tailwater Practice Partners 1701 E 10th St Rolla MO 65401-4601 Ph: (573) 364-1599 |
| NPI Number | 1073393336 |
|---|---|
| Provider Enumeration Date | 10/04/2023 |
| Last Update Date | 10/04/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073393336 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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