| NPI | 1275745721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HARLAN JOSEPH WILSON President 314-352-4820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 013008) |
| Enumeration Date | 2007-05-05 |
| Last Update Date | 2020-08-22 |