| NPI | 1609995109 |
|---|---|
| Other Name | TRIAD DENTAL |
| Entity Type | Organization |
| Authorized Contact | JAMES GLENNON EVANS Dentist 636-441-7440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MO 013030) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2020-08-22 |