Individual
MARY JANE SUPPASANSATHORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
7316 RAYTOWN ROAD, RAYTOWN, MO 64133
(816) 353-0140
Mailing address
7316 RAYTOWN ROAD, RAYTOWN, MO 64133
(816) 353-0140
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
014840
MO
Other
Enumeration date
12/06/2006
Last updated
07/08/2007
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