Organization
MATTHEW THERIAC, D.D.S. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW THERIAC D.D.S. (DOCTOR/OWNER)
(660) 385-3623
Entity
Organization
Contact information
Practice address
905 JACKSON ST, MACON, MO 63552-2016
(660) 385-3623
Mailing address
905 JACKSON ST, MACON, MO 63552-2016
(660) 385-3623
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
15187
MO
Other
Enumeration date
09/26/2007
Last updated
09/26/2007
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