| NPI | 1104554179 |
|---|---|
| Doing Business As | GLENDALE ORTHODONTICS |
| Entity Type | Organization |
| Authorized Contact | ASHLY KRISTINE SUNSHINE Credentialing Specialist 314-413-2803 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2022-08-09 |
| Last Update Date | 2023-04-20 |