| NPI | 1780120410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERVIN SIMMONS Owner 314-837-3232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MO 13607) |
| Enumeration Date | 2017-01-19 |
| Last Update Date | 2017-01-19 |