| NPI | 1508416967 |
|---|---|
| Doing Business As | BOARDWALK FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | KIRSTEN BURKEMPER Front Desk 636-561-4117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2019-09-19 |