| NPI | 1174619514 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOUISE ROBERTA FIRST Dentist 314-837-2120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 015538) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 015538) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2021-10-20 |