| NPI | 1255816906 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLY SUNSHINE Regional Support Specialist 636-362-4986 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2018-09-28 |
| Last Update Date | 2024-11-05 |