Individual
DIANE KO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
1314 BRENDA AVE, PERRYVILLE, MO 63775-2303
(573) 517-0405
(573) 517-0420
Mailing address
408 S BROADVIEW ST, CAPE GIRARDEAU, MO 63703-5725
(573) 332-0808
(573) 339-7945
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2014027291
MO
Other
Enumeration date
08/11/2014
Last updated
08/18/2015
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