Individual
BRIAN LAFORGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10803 E 350 HWY, RAYTOWN, MO 64138-2313
(816) 358-4008
Mailing address
10803 E 350 HWY, RAYTOWN, MO 64138-2313
(816) 358-4008
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2019031262
MO
Other
Enumeration date
08/13/2019
Last updated
08/13/2019
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