Individual
KYLE SAMPLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
821 WESTWOOD DR, SEDALIA, MO 65301-2102
(660) 826-4774
(660) 826-1300
Mailing address
1411A N JEFFERSON ST, CARROLLTON, MO 64633-1945
(660) 542-6066
(660) 646-3887
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2011015414
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/07/2011
Last updated
07/28/2016
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