Individual
DR. MATHEW S. AUSMUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1050 W 10TH ST, ROLLA, MO 65401
(573) 426-2233
(573) 364-3993
Mailing address
PO BOX 579, ROLLA, MO 65402
(573) 458-3425
(573) 426-2282
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
014015
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
408413003
—
MO
Enumeration date
10/27/2005
Last updated
08/22/2019
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