| NPI | 1528889292 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXIS POLCZYNSKI Owner/Doctor 618-920-3473 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-10-24 |
| Last Update Date | 2024-10-24 |