Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 011045 | MO |
NPI | 1124164785 |
---|---|
Provider Name | Mr. Robert Marion Jarrett |
First Address | Manchester, MO 63011-2964 |
Second Address | Clayton, MO 63105-1711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |