NPI | 1265498844 |
---|---|
Entity Type | Organization |
Authorized Contact | DERRICK O NEAL FRYE President Dentist 314-863-3772 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO DE015374) |
Enumeration Date | 2006-04-24 |
Last Update Date | 2020-08-22 |