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Organization

BUFFALO PRAIRIE DENTAL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CAROL JEAN THROCKMORTON (OFFICE MANAGER)
(417) 345-2793
Entity
Organization

Contact information

Practice address
1006 S. ASH, BUFFALO, MO 65622-0707
(417) 345-2793
(417) 345-8654
Mailing address
PO BOX 707, 1006 S. ASH, BUFFALO, MO 65622-0707
(417) 345-2793
(417) 345-8654

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
012536
MO

Other

Enumeration date
12/21/2011
Last updated
12/21/2011
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