| NPI | 1639224876 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPJ A RENNER Owner 618-233-7300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics |
| Additional Taxonomies | 1223P0300X Dentist Periodontics |
| 1223P0300X Dentist Periodontics | |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2020-08-22 |