| NPI | 1548637853 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTOPHER CHILCUTT Member 314-569-3660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MO 2010018554) |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2015-08-24 |