| NPI | 1306150958 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA J MCDONALD Owner/Dentist 314-727-1319 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2001022020) |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2010-08-05 |