Individual
DR. CHARLES EDWARD NIESEN II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2440 S BRENTWOOD BLVD, SAINT LOUIS, MO 63144-2321
(314) 962-6643
(314) 962-2205
Mailing address
2440 S BRENTWOOD BLVD, SAINT LOUIS, MO 63144-2321
(314) 962-6643
(314) 962-2205
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
012230
MO
Other
Enumeration date
12/13/2006
Last updated
07/08/2007
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