| NPI | 1215547997 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY LEA BOMMARITO Office Manager 314-862-7844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2020-08-06 |
| Last Update Date | 2020-08-06 |