| NPI | 1528503026 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEWART E MORELAND Member Manager 314-569-1012 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2016-12-20 |
| Last Update Date | 2016-12-20 |