Tailwater Practice Partners

NPI #1073393336 in Rolla, Missouri

Provider Information

NPI Number: 1073393336
Entity Type: Organization
Organization Name: Tailwater Practice Partners
Subpart: Yes (part of a larger organization)
Parent Organization: TW NEW DENTISTRY, PLLC
Primary Specialty: Clinic/Center - Dental
Enumeration Date: Oct 4, 2023
Last Updated: Oct 4, 2023

Practice Location

Address: 1701 E 10TH ST
City: Rolla
State: Missouri
ZIP Code: 65401-4601
Phone: (573) 364-1599

Authorized Official

Name: MR. RYAN MCCOSTLIN
Title: CEO
Phone: (615) 479-2196

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Dental — Dental	261QD0000X	Primary

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