| NPI | 1063761773 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS F. MOONEY Member / Manager 636-970-4700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: MO 015486) |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2012-09-10 |