| NPI | 1144686320 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND J SKOSKY Sole Member 314-353-0263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MO 014508) |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2016-01-04 |