Provider Demographics
NPI:1184902587
Name:CORNERSTONE FAMILY DENTAL, MARK SALADIN, D.M.D. AND LOUIS DRACKERT, D.
Entity type:Organization
Organization Name:CORNERSTONE FAMILY DENTAL, MARK SALADIN, D.M.D. AND LOUIS DRACKERT, D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NAVON
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-358-3361
Mailing Address - Street 1:1604 MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-3059
Mailing Address - Country:US
Mailing Address - Phone:417-358-3361
Mailing Address - Fax:417-358-4222
Practice Address - Street 1:1604 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-3059
Practice Address - Country:US
Practice Address - Phone:417-358-3361
Practice Address - Fax:417-358-4222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty