| NPI | 1992036495 |
|---|---|
| Doing Business As | WILDHORSE DENTAL |
| Entity Type | Organization |
| Authorized Contact | EARL ROBERT LARSON President 636-537-0447 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 13769) |
| Enumeration Date | 2010-01-22 |
| Last Update Date | 2018-01-24 |