| NPI | 1952497901 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN CHARLES BEYERSDORFER Owner Dentist 618-622-0212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2022-07-21 |