Provider Demographics
NPI:1417192048
Name:GOWER DENTAL CARE, LLC
Entity Type:Organization
Organization Name:GOWER DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDDART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-424-6222
Mailing Address - Street 1:311 S 169 HWY
Mailing Address - Street 2:
Mailing Address - City:GOWER
Mailing Address - State:MO
Mailing Address - Zip Code:64454
Mailing Address - Country:US
Mailing Address - Phone:816-424-6222
Mailing Address - Fax:
Practice Address - Street 1:311 S 169 HWY
Practice Address - Street 2:
Practice Address - City:GOWER
Practice Address - State:MO
Practice Address - Zip Code:64454
Practice Address - Country:US
Practice Address - Phone:816-424-6222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010142061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty