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Organization
CORDELL LAKE, D.D.S., LLC
Active
Organization
CORDELL LAKE, D.D.S., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORDELL LAKE DDS (GENERAL DENTIST)
(816) 728-1630
Entity
Organization
Contact information
Practice address
12 E HARRISON ST, FARMINGTON, MO 63640-1859
(573) 756-4344
Mailing address
3145 CROSS CREEK DR, CAMDENTON, MO 65020-9377
(816) 728-1630
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
NULL
Other
Enumeration date
11/15/2018
Last updated
11/15/2018
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