| NPI | 1053346122 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARYL JOHN MARTIN Owner/Operator 636-343-1550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 010150) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2008-05-16 |