Organization
SULLIVAN DENTAL PARTNERSHIP LLC
Active
Other names
Barry D Brace DMD & Associates
Organization subpart
No
Provider details
NPI number
Authorized official
BARRY D BRACE MD (PRESIDENT)
(573) 860-2552
Entity
Organization
Contact information
Practice address
300 WALMART DR, SULLIVAN, MO 63080-3333
(573) 860-2552
(573) 860-4553
Mailing address
300 WALMART DR, SULLIVAN, MO 63080-3333
(573) 860-2552
(573) 860-4553
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
12409
MO
Other
Enumeration date
01/19/2011
Last updated
01/19/2011
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