| NPI | 1457552697 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM G DEWERT Member 314-739-3300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 12134) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2020-08-22 |