| NPI | 1083985345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA SELENE OLVERA General Dentist 314-367-1434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2009024563) |
| Enumeration Date | 2012-01-18 |
| Last Update Date | 2012-01-18 |