| NPI | 1558516120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SALLY ANN BOURIL Receptionist 636-528-6820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 14467) |
| Enumeration Date | 2008-11-24 |
| Last Update Date | 2008-11-24 |