Organization
BRICK CITY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTOPHER KOLLATH DDS (OWNER DENTIST)
(954) 790-4438
Entity
Organization
Contact information
Practice address
3612 S CLARK ST, MEXICO, MO 65265-4104
(573) 581-4352
Mailing address
3612 S CLARK ST, MEXICO, MO 65265-4104
(573) 581-4352
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
11/01/2021
Last updated
11/01/2021
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