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Organization
ST LOUIS DENTAL IMPLANT GROUP
Active
Organization
ST LOUIS DENTAL IMPLANT GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ALAN MANGELS DMD (OWNER)
(636) 970-0295
Entity
Organization
Contact information
Practice address
3750 GREEN MOUNT CROSSING DR, SHILOH, IL 62269
(314) 729-7840
Mailing address
11222 TESSON FERRY RD, SAINT LOUIS, MO 63123-6963
(314) 729-7840
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
IL
1223P0300X
Periodontics
—
IL
Other
Enumeration date
04/18/2008
Last updated
04/18/2008
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