Individual
GRANT ALOYSIUS POWDERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1780 OLD HIGHWAY 50 E, UNION, MO 63084-3219
(844) 853-8937
Mailing address
1800 COMMUNITY, CLINTON, MO 64735-8804
(844) 853-8937
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2024019734
MO
Other
Enumeration date
06/03/2024
Last updated
06/03/2024
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