| NPI | 1689766123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY RAYMOND RIESER Member/Partner 636-239-7654 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO LC0523694) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2020-08-22 |