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1224 Graham Rd Suite 2002 Florissant MO 63031-8028 | |
| (314) 838-3737 | |
| (314) 838-1625 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1224 Graham Rd, Florissant, Missouri |
| Authorized Official Name and Position | Celia Hayes (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2175402100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1224 Graham Road Suite 2002 Florissant MO 63031 Ph: (314) 838-3737 | 1224 Graham Rd Suite 2002 Florissant MO 63031-8028 Ph: (314) 838-3737 |
| NPI Number | 1205979853 |
|---|---|
| Provider Enumeration Date | 02/14/2007 |
| Last Update Date | 03/10/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205979853 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Secondary |
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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