| NPI | 1356465629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT DEE BANKHEAD Doctor 636-332-2350 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2008-08-04 |