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1005 Dunn Rd Florissant MO 63031-8205 | |
| (314) 838-9454 | |
| (314) 838-9414 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1005 Dunn Rd, Florissant, Missouri |
| Authorized Official Name and Position | Elliot I Leon (OWNER) |
| Authorized Official Contact | 3148389454 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1005 Dunn Rd Florissant MO 63031-8205 Ph: (314) 838-9454 | 1005 Dunn Rd Florissant MO 63031-8205 Ph: (314) 838-9454 |
| NPI Number | 1679763411 |
|---|---|
| Provider Enumeration Date | 07/27/2007 |
| Last Update Date | 07/31/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679763411 | NPI | - | NPPES |
| 12522 | Other | MO | MISSOURI STATE LICENSE # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 12522 (Missouri) | Primary |
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