Organization
CREVE COEUR PERIODONTICS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARWAN ASSAF D.M.D., M.S.D. (OWNER)
(314) 567-3760
Entity
Organization
Contact information
Practice address
11709 OLD BALLAS RD, SUITE 206, CREVE COEUR, MO 63141-7029
(314) 567-3760
(314) 567-3929
Mailing address
11709 OLD BALLAS RD, SUITE 206, CREVE COEUR, MO 63141-7029
(314) 567-3760
(314) 567-3929
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
14247
MO
Other
Enumeration date
05/06/2008
Last updated
05/06/2008
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