| NPI | 1912471921 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM JOHN PAVLISIN Owner 314-481-5150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 261Q00000X |
| Enumeration Date | 2019-01-14 |
| Last Update Date | 2019-01-14 |