| NPI | 1790276764 |
|---|---|
| Doing Business As | BROOKSIDE FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | STACY M MARTIN Office Manager 636-240-1750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2018-05-24 |