| NPI | 1558694083 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE D. HODGE Office Manager 636-239-7150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MO 014793) |
| Enumeration Date | 2009-09-16 |
| Last Update Date | 2009-09-16 |