| NPI | 1962036350 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SONU MUTHUVALLIAPPAN Dmd/Owner 636-489-9330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2020-02-25 |
| Last Update Date | 2020-02-25 |