| NPI | 1346605219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES DANIEL HURLEY Manager 314-576-1777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MO 2014015546) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MO 2014015542) |
| Enumeration Date | 2015-12-20 |
| Last Update Date | 2015-12-20 |