Organization
STATE FAIR DENTAL LLC
Active
Other names
Hometown Dental
Organization subpart
No
Provider details
NPI number
Authorized official
FAITH GASKINS (DIRECTOR OF CREDENTIALING)
(630) 877-3520
Entity
Organization
Contact information
Practice address
1806 W 5TH ST, SEDALIA, MO 65301-2420
(972) 869-3789
Mailing address
1806 W 5TH ST, SEDALIA, MO 65301-2420
(972) 869-3789
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
12/10/2020
Last updated
12/10/2020
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