| NPI | 1972601201 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH REITZ FASSLER Owner Dentist 636-937-5118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO D15559) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-08-22 |