Dr. Stephen C. Waller, DDS, LLC
Organization Active NPI General Practice Dentistry · Ellington, MO
NPI 1992984173 · NPPES record last updated Jan 22, 2009
Key facts
- NPI
- 1992984173
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 1999135982 (MO)
- Legal business name
- DR. STEPHEN C. WALLER, DDS, LLC
- Practice address
- 115 Walnut St
Ellington, MO 63638 - Phone
- (573) 756-4344
- Fax
- (573) 756-4699
- NPI assigned
- Oct 24, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Stephen C. Waller, D.D.S.
- Title
- Dentist
- Phone
- (573) 756-4344
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | 1999135982 | MO | Yes |
Addresses
Primary practice location
115 Walnut St
Ellington, MO 63638
Mailing address
PO Box 157
110 S. 2ND St
Ellington, MO 63638-0157
Phone (573) 663-2313
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578574240 | Other | MO | TYPE 1 NPI NUMBER |
Other providers in Ellington, MO
- Sherilyn K Clark
- Deelaney Rae-Ann Crocker
- Bradley R Daniel
- Brooklynn Renee Dement
- Natalie Donnell
- Megan S Drake
- Ellington 1 Inc
- Stella Diane Fernandes
- Deeanna Lynn Freeman
- Scott Lee Fulkerson
All providers in Ellington, MO · General Practice Dentistry in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.