| NPI | 1780773242 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY J. PERNOUD President 636-937-1515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MO 012735) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2013-07-29 |