| NPI | 1992889166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLLIE CHRISTOPHER FISHER Owner 314-837-9777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 12781) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2020-08-22 |