Individual
SAMUEL JOHN DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
519 SW 3RD ST STE G, LEES SUMMIT, MO 64063-2278
(816) 524-3434
Mailing address
519 SW 3RD ST STE G, LEES SUMMIT, MO 64063-2278
(816) 524-3434
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2024021490
MO
Other
Enumeration date
05/21/2024
Last updated
06/11/2024
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