| NPI | 1245390798 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS R WIEDEMANN President 314-645-6400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MO 13165) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2020-08-22 |