| NPI | 1174642581 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL HERBERT BOEHME Owner 314-892-8853 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 014743) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2020-08-22 |