Organization
RYAN RADER ENTERPRISES DMD LLC
Active
Other names
Creve Coeur Periodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN LEE RADER D.M.D., M.S. (OWNER)
(314) 567-3760
Entity
Organization
Contact information
Practice address
11709 OLD BALLAS RD, STE 206, CREVE COEUR, MO 63141-7029
(314) 567-3760
(314) 567-3929
Mailing address
11709 OLD BALLAS RD, STE 206, CREVE COEUR, MO 63141-7029
(314) 567-3760
(314) 567-3929
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
2006016236
MO
Other
Enumeration date
03/28/2014
Last updated
03/28/2014
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