| Provide Dental | |
|
2211 Olive St Ste 100 Saint Louis MO 63103-1502 | |
| (314) 776-7100 | |
| Not Available |
| Full Name | Provide Dental |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2211 Olive St Ste 100, Saint Louis, Missouri |
| Authorized Official Name and Position | Philip Son (OWNER/ GENERAL DENTIST) |
| Authorized Official Contact | 3237879397 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Provide Dental 2309 Barrett Place Ct Ballwin MO 63021-7829 Ph: (323) 787-9397 | Provide Dental 2211 Olive St Ste 100 Saint Louis MO 63103-1502 Ph: (314) 776-7100 |
| NPI Number | 1760253694 |
|---|---|
| Provider Enumeration Date | 01/10/2024 |
| Last Update Date | 01/10/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760253694 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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