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Organization
RYAN RADER ENTERPRISES DMD LLC
Active
Organization
RYAN RADER ENTERPRISES DMD LLC
Active
Other names
Creve Coeur Periodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN LEE RADER D.M.D., M.S. (OWNER)
(314) 567-3760
Entity
Organization
Contact information
Practice address
11709 OLD BALLAS RD, STE 206, CREVE COEUR, MO 63141-7029
(314) 567-3760
(314) 567-3929
Mailing address
11709 OLD BALLAS RD, STE 206, CREVE COEUR, MO 63141-7029
(314) 567-3760
(314) 567-3929
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
2006016236
MO
Other
Enumeration date
03/28/2014
Last updated
03/28/2014
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