| NPI | 1649437112 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM CHARLES DALE Sole Member 636-928-1167 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MO 014742) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2008-05-21 |