| NPI | 1053538504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLIOT GLENN GLASSMAN Owner 636-757-0770 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 013277) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2020-08-22 |