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 |