| NPI | 1154675262 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIN MARISCAL Owner 636-464-6444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: MO 2003013103) |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2021-07-13 |