NPI | 1023613163 |
---|---|
Doing Business As | FORUM DENTAL - ST. LOUIS |
Entity Type | Organization |
Authorized Contact | TABATHA LEMKE Credentialing Coordinator 217-540-6078 |
Organization Subpart ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Enumeration Date | 2020-12-04 |
Last Update Date | 2020-12-04 |