Boulevard Dental Care L.L.C.
Dentist, General Practice in Saint Charles, MO. Organization (NPI-2).
NPI number1831247048
StatusActive
Last updated in NPPESJul 30, 2007
Details
- NPI
- 1831247048
- Entity type
- Organization (NPI-2)
- Legal business name
- Boulevard Dental Care L.L.C.
- Organization subpart
- No
- Enumeration date
- Jan 7, 2007
- Last updated
- Jul 30, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Practice location
2645 Muegge RdSaint Charles, MO 63303-3145
Phone 636-939-6868 · Fax 636-447-3611
Mailing address
11939 Manchester Rd#120
Des Peres, MO 63131-4502
Phone 636-939-6868 · Fax 636-447-3611
Authorized official
Randall Craig Reyes
Manager
6369396868
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