| NPI | 1043479215 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NUMPOL DEJTIRANUKUL Single Member 636-300-4280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2000170243) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2008-06-03 |