Individual
GREGORY PERNOUD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1204 E STATE ROUTE 72, ROLLA, MO 65401-3938
(573) 364-1934
(573) 364-8110
Mailing address
112 S 2ND ST, FESTUS, MO 63028-2201
(636) 937-1515
(636) 937-0790
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
012735
MO
Other
Enumeration date
09/16/2013
Last updated
09/16/2013
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