| NPI | 1780140459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVAN BROWN Director 314-469-0964 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-02-18 |
| Last Update Date | 2019-02-18 |