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Organization · General Practice Dentistry · O Fallon, MO

NPI
1033383997
Type
Organization (Type 2)
Primary specialty
General Practice Dentistry (Dentist)
Specialty group
Dental Providers
Taxonomy code
1223G0001X
License number
014964 (MO)
Enumerated
2008-04-22
Last updated
2008-04-22
Practice location
9210 Phoenix Village Pkwy
O Fallon, MO 63368-4779
(636) 561-1154

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