| NPI | 1306059654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA RENEE CLABON Chief Executive Officer 314-367-5820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MO 519) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2018-06-07 |