16111 MANCHESTER ROAD, L.L.C.
Organization (NPI-2)
Active
Dentist, General Practice
Provider Information
- NPI Number
1013386598- Provider Type
- Organization / Facility (NPI-2)
- Status
- Active
Contact & Location
- Address
- 428 OLD STATE RD., ELLISVILLE, MO, 63021
- Phone
- (636) 391-6030
- Fax
- (636) 527-8386
Specialties & Taxonomies
Dentist, General Practice
License: MO #2000165488
Dentist, General Practice
Primary License: MO #2000169958