# VOYAGE03, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Northside Family Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811773674
- **Authorized official:** KIM JIMENEZ (OFFICE MANAGER)
- **Authorized official phone:** (636) 431-8600

## Contact information

- **Practice address:** 472 HIGHWAY P, O FALLON, MO 63366-1591
- **Practice address phone:** (636) 431-8600
- **Practice address fax:** (636) 215-8296
- **Mailing address:** 472 HIGHWAY P, O FALLON, MO 63366-1591
- **Mailing address phone:** (636) 431-8600
- **Mailing address fax:** (636) 215-8296

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/06/2023
- **Last updated:** 09/19/2023