| NPI | 1447703590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANICE E PELLEY Practice Manager 314-965-6503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2002013144) |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2016-07-25 |