Samuel E Deatherage Dmd PC
NPI #1619040078 in Mountain Grove, Missouri
Provider Information
- NPI Number
- 1619040078
- Entity Type
- Organization
- Organization Name
- Samuel E Deatherage Dmd PC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Nov 15, 2006
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 920 NORTH MAIN
- City
- Mountain Grove
- State
- Missouri
- ZIP Code
- 65711-1315
- Phone
- (417) 926-4910
Authorized Official
- Name
- SAMUEL E DEATHERAGE, DMD
- Title
- PRESIDENT
- Phone
- (417) 926-4910
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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