| NPI | 1477253268 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLY SUNSHINE Credentialing 636-362-4986 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-03-09 |
| Last Update Date | 2023-03-24 |