| NPI | 1073709226 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA MARIE GRAESER Insurance 314-434-0493 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery |
| Enumeration Date | 2007-09-21 |
| Last Update Date | 2023-02-28 |