Individual
DR. MADISON CLARE ETLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4620 HAMPTON AVE, SAINT LOUIS, MO 63109-2714
(314) 752-7468
Mailing address
738 VISTA GLEN CT, EUREKA, MO 63025-2086
(314) 619-9512
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2023021431
MO
1223G0001X
General Practice Dentistry
2023021431
MO
Other
Enumeration date
06/09/2023
Last updated
06/09/2023
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