Organization
NA NIEWDACH INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE NIEWDACH (OWNER)
(314) 394-2828
Entity
Organization
Contact information
Practice address
11648 MANCHESTER RD, DES PERES, MO 63131-4612
(314) 394-2828
Mailing address
11648 MANCHESTER RD, DES PERES, MO 63131-4612
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/28/2018
Last updated
12/28/2018
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