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Organization
EDP OF MISSOURI PC
Active
Organization
EDP OF MISSOURI PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA GARIBAY (CREDENTIALING MANAGER)
(312) 736-8963
Entity
Organization
Contact information
Practice address
677 N NEW BALLAS RD STE 207, CREVE COEUR, MO 63141-6732
(314) 569-3141
Mailing address
141 W JACKSON BLVD STE 210, CHICAGO, IL 60604-3048
(312) 937-3619
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
NULL
Other
Enumeration date
12/27/2017
Last updated
09/20/2021
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