| NPI | 1548708308 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK HUMPHREY Manager 636-734-6896 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 2014016805) |
| Enumeration Date | 2017-02-01 |
| Last Update Date | 2017-02-01 |