| NPI | 1093856163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYANN LEE SUMMERFORD Dental Program COO Rdinatoer 636-282-1010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare (Licence: MO 16116011) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2007-08-23 |