| NPI | 1164052973 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIVAM PARBHU Owner 314-550-3005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2020-01-21 |
| Last Update Date | 2020-01-21 |