| NPI | 1811448863 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL TRAVIS Dentist 314-452-1423 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MO 2011019745) |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2016-10-14 |