| NPI | 1104929710 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAWN M. PICARD Office Manager 314-727-6676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 012119) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2008-08-14 |