| NPI | 1891291712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLY SUNSHINE Credentialing Specialist 314-413-2803 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2024-06-14 |