| NPI | 1255759197 |
|---|---|
| Doing Business As | CREVE COEUR PERIODONTICS |
| Entity Type | Organization |
| Authorized Contact | RYAN LEE RADER Owner 314-567-3760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MO 2006016236) |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2014-03-28 |