| NPI | 1750793709 |
|---|---|
| Doing Business As | PINE LAWN DENTAL |
| Entity Type | Organization |
| Authorized Contact | MICHAEL PATRICK TRAVIS Dentist 314-382-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2011019745) |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2014-05-27 |