| NPI | 1922671163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL GRASSO Doctor 636-777-7700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 122400000X Denturist |
| Enumeration Date | 2021-07-23 |
| Last Update Date | 2021-07-23 |