Individual
STAS VIDYAKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
220 SOUTHLAND DR, SIKESTON, MO 63801-4403
(573) 471-4167
(573) 471-4212
Mailing address
6738 STATE HIGHWAY 77, BENTON, MO 63736-8238
(573) 313-2500
(573) 313-2505
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2019019577
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
400070483
—
MO
Enumeration date
06/05/2019
Last updated
03/12/2020
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