| NPI | 1821216060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR L CLARK Owner 314-739-3700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2003012113) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 14202) |
| 1223G0001X Dentist, General Practice (Licence: MO 013326) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2020-08-22 |