| NPI | 1912405762 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAKE WESTRA Owner 314-660-7780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2018-01-26 |
| Last Update Date | 2018-01-26 |