| NPI | 1952788762 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID GUILBEAULT Dentist/Owner 618-248-2038 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12012272A) |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2016-03-11 |