| NPI | 1174618045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SRDJAN ILIC-SILJAK Dentist 314-962-6622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 013556) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2011-10-11 |