| NPI | 1245301134 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLY SUNSHINE Credentialing Specialist 314-413-2803 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: HI DT-1398) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2025-04-07 |