| NPI | 1902511454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOLLY ELLIS Owner/Dentist 314-210-5150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2023-01-19 |
| Last Update Date | 2023-01-19 |