Organization
ROLLA FAMILY DENTISTRY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY KIERSZ DDS (OWNER/PRESIDENT)
(573) 364-1599
Entity
Organization
Contact information
Practice address
1701 E 10TH ST, ROLLA, MO 65401-4601
(573) 364-1599
Mailing address
1701 E 10TH ST, ROLLA, MO 65401-4601
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
015882
MO
Other
Enumeration date
10/10/2014
Last updated
10/10/2014
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