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Individual

DR. JACKY CLAY STANDLEE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
WESTSIDE DENTAL 994 DIAMOND RIDGE, STE 202, JEFFERSON CITY, MO 65109
(573) 893-4402
(573) 632-4398
Mailing address
5405 WARDSVILLE RD, JEFFERSON CITY, MO 65101-8744
(573) 634-7313

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
014960
MO

Other

Enumeration date
08/09/2006
Last updated
07/08/2007
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