Individual
SHELBY BLADE GLENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
15700 N US HIGHWAY 169 STE C-2, SMITHVILLE, MO 64089-9183
(816) 343-9100
Mailing address
4613 NW KLAMM RD, RIVERSIDE, MO 64150-9750
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2023021093
MO
Other
Enumeration date
06/09/2023
Last updated
06/12/2023
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