| NPI | 1831349232 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA C. NIEVA Dentist/President 636-326-7633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MO 2002016551) |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2008-09-23 |