Individual
TALVA GRUNDSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D,M,D,
Contact information
Practice address
2022 WILLIAMS ST, JEFFERSON CITY, MO 65109-1186
(573) 634-4414
(573) 634-8385
Mailing address
2022 WILLIAMS ST, JEFFERSON CITY, MO 65109-1186
(573) 634-4414
(573) 634-8385
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
014579
MO
Other
Enumeration date
09/20/2006
Last updated
07/08/2007
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