| NPI | 1679911325 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFF JOHNSON Dentist 314-427-7400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MO Mo 12260) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2005017506) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2013-06-04 |