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Organization
PROVIDE DENTAL
Active
Organization
PROVIDE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILIP SON DMD (OWNER/ GENERAL DENTIST)
(323) 787-9397
Entity
Organization
Contact information
Practice address
2211 OLIVE ST STE 100, SAINT LOUIS, MO 63103-1502
(314) 776-7100
Mailing address
2309 BARRETT PLACE CT, BALLWIN, MO 63021-7829
(323) 787-9397
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
NULL
Other
Enumeration date
01/10/2024
Last updated
01/10/2024
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