Organization
WILDHORSE DENTAL CARE, LLC
Active
Other names
New Creation Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW BOSCIA DMD (PRESIDENT)
(636) 561-6400
Entity
Organization
Contact information
Practice address
191 CIVIC CENTER DR, LAKE ST LOUIS, MO 63367-3027
(636) 561-6400
Mailing address
191 CIVIC CENTER DR, LAKE ST LOUIS, MO 63367-3027
(636) 561-6400
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/05/2020
Last updated
07/13/2021
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