| NPI | 1558895490 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOLLY CHRISTINE ELLIS Owner 314-965-1334 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MO 2006021179) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2017-04-18 |