| NPI | 1043662885 |
|---|---|
| Doing Business As | MISSOIN EAST DALLAS |
| Entity Type | Organization |
| Authorized Contact | CHARLES J WILTRAUT Chief Executive Officer 610-349-7319 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2016-07-05 |
| Last Update Date | 2016-07-05 |