| NPI | 1487389672 |
|---|---|
| Doing Business As | GATEWAY LITTLE SMILES OF BALLWIN |
| Entity Type | Organization |
| Authorized Contact | COREY HASTINGS Managing Member 314-496-3562 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2022-07-21 |
| Last Update Date | 2022-07-21 |