Individual
DR. KEVIN MARK MATTINGLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
22 S WEST ST, PERRYVILLE, MO 63775-2547
(573) 547-6691
Mailing address
22 S WEST ST, PERRYVILLE, MO 63775-2547
(573) 547-6691
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2022018780
MO
Other
Enumeration date
06/02/2022
Last updated
06/02/2022
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