| NPI | 1275770513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL PATRICK WALLACE Owner 314-968-0003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 13992) |
| Enumeration Date | 2009-01-08 |
| Last Update Date | 2009-01-08 |