| NPI | 1811761190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ANDREW MORLEY Manager 618-559-6662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2023-11-08 |
| Last Update Date | 2025-02-06 |