Organization
PLAZA DENTAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CINDY M SOOTER (OFFICE MANAGER)
(573) 817-2222
Entity
Organization
Contact information
Practice address
303 N KEENE ST, STE 208, COLUMBIA, MO 65201-6623
(573) 817-2222
(573) 817-2888
Mailing address
303 N KEENE ST, STE 208, COLUMBIA, MO 65201-6623
(573) 817-2222
(573) 817-2888
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
200613508
MO
1223G0001X
General Practice Dentistry
Primary
2008006645
MO
1223P0221X
Pediatric Dentistry
010435
MO
1223P0221X
Pediatric Dentistry
01348
MO
Other
Enumeration date
01/09/2008
Last updated
06/17/2008
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