| NPI | 1952714792 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN C WALDE Owner 636-239-5151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 013936) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2014-06-10 |