| Wildhorse Dental | |
|
150 Long Road Ste 100 Chesterfield MO 63005 | |
| (636) 537-0447 | |
| (636) 537-9452 |
| Full Name | Wildhorse Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 150 Long Road Ste 100, Chesterfield, Missouri |
| Authorized Official Name and Position | Earl Robert Larson (PRESIDENT) |
| Authorized Official Contact | 6365370447 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wildhorse Dental 150 Long Road Ste 100 Chesterfield MO 63005 Ph: (636) 537-0447 | Wildhorse Dental 150 Long Road Ste 100 Chesterfield MO 63005 Ph: (636) 537-0447 |
| NPI Number | 1992036495 |
|---|---|
| Provider Enumeration Date | 01/22/2010 |
| Last Update Date | 01/24/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992036495 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 13769 (Missouri) | Primary |
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