Individual
DR. TED A DEATHERAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1616 GIBSON ST, WEST PLAINS, MO 65775-1814
(417) 257-0126
(417) 256-2469
Mailing address
1616 GIBSON ST, WEST PLAINS, MO 65775-1814
(417) 257-0126
(417) 256-2469
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DEA015659
MO
Other
Enumeration date
01/03/2007
Last updated
07/08/2007
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