| NPI | 1336365956 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA M POPPE Practice Administrator 314-842-4699 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2023-06-30 |