NPI | 1750868915 |
---|---|
Entity Type | Organization |
Authorized Contact | BLAKE ANTHONY FERANDO Doctor 636-978-6400 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2018015357) |
Enumeration Date | 2018-07-20 |
Last Update Date | 2018-07-20 |