# CALLAWAY FAMILY DENTAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699484840
- **Authorized official:** ALEX MADOV DDS (MEMBER)
- **Authorized official phone:** (402) 850-9285

## Contact information

- **Practice address:** 2424 N BLUFF ST, FULTON, MO 65251-2709
- **Practice address phone:** (573) 642-6904
- **Mailing address:** 2424 N BLUFF ST, FULTON, MO 65251-2709
- **Mailing address phone:** (573) 642-6904

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/16/2022
- **Last updated:** 11/16/2022