Organization
G. WENDELL WEATHERS, D.D.S., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GRANT WENDELL WEATHERS JR. D.D.S. (PRESIDENT)
(573) 471-5155
Entity
Organization
Contact information
Practice address
405 TANNER ST, SIKESTON, MO 63801-4272
(573) 471-5155
Mailing address
405 TANNER ST, SIKESTON, MO 63801-4272
(573) 471-5155
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
14998
MO
Other
Enumeration date
06/04/2008
Last updated
06/04/2008
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