| 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 |