Organization
SOUTHSIDE DENTAL CARE, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRI HUONG LY D.D.S. (DENTIST)
(314) 865-3838
Entity
Organization
Contact information
Practice address
3654 GRAVOIS AVE, SAINT LOUIS, MO 63116-4728
(314) 865-3838
(314) 865-2419
Mailing address
3654 GRAVOIS AVE, SAINT LOUIS, MO 63116-4728
(314) 865-3838
(314) 865-2419
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
200-101-1347
MO
Other
Enumeration date
04/18/2007
Last updated
08/22/2020
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