| NPI | 1972039501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM EDWARD UTHOFF Sole Memeber 314-842-0440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: MO 013578) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2017-05-02 |