Individual
DR. HENRY JOSEPH ANTOLAK II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1201 FORUM DR, ROLLA, MO 65401-2587
(573) 364-1821
Mailing address
12303 HUMMINGBIRD PL, ROLLA, MO 65401-7406
(573) 364-0705
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
13190
MO
Other
Enumeration date
11/01/2006
Last updated
07/08/2007
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