Organization
CLEAR CREEK FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSHUA TANNER RUST DDS (PRESIDENT/OWNER)
(417) 751-9112
Entity
Organization
Contact information
Practice address
609 E WELLS ST STE F, ASH GROVE, MO 65604-9087
(417) 751-9112
Mailing address
609 E WELLS ST STE F, ASH GROVE, MO 65604-9087
(417) 751-9112
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2009013248
MO
Other
Enumeration date
03/02/2010
Last updated
03/02/2010
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