| NPI | 1700172806 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDACE THERESE WAKEFIELD Owner 314-830-9663 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MO 2000175293) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2011-06-27 |