| NPI | 1912019290 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID M IVEY President 636-928-7217 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MO 012332) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-08-22 |