Organization
SAMUEL E DEATHERAGE DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL E DEATHERAGE DMD (PRESIDENT)
(417) 926-4910
Entity
Organization
Contact information
Practice address
920 NORTH MAIN, MOUNTAIN GROVE, MO 65711-1315
(417) 926-4910
(417) 926-4399
Mailing address
920 NORTH MAIN, MOUNTAIN GROVE, MO 65711-1315
(417) 926-4910
(417) 926-4399
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
11/15/2006
Last updated
08/22/2020
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