| 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 |