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Individual

NATHAN JOHN PROCTOR

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
1724 NEBRASKA AVE., FORT LEONARD WOOD, MO 65473
(573) 596-0408
Mailing address
1724 NEBRASKA AVE, FORT LEONARD WOOD, MO 65473-8939
(573) 596-0408

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8444191-9922
UT

Other

Enumeration date
10/15/2012
Last updated
10/15/2012
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