Individual
STEPHEN G MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1316 E INDEPENDENCE ST, SPRINGFIELD, MO 65804-4262
(417) 889-0700
(417) 882-0706
Mailing address
1316 E INDEPENDENCE ST, SPRINGFIELD, MO 65804-4262
(417) 889-0700
(417) 882-0706
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2010016642
MO
Other
Enumeration date
06/02/2010
Last updated
06/02/2010
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