Individual
MARISSA GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1500 PARK AVE, SAINT LOUIS, MO 63104-3024
(314) 252-8196
Mailing address
1418 CARROLL ST UNIT 106, SAINT LOUIS, MO 63104-3361
(314) 252-8196
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/27/2024
Last updated
06/27/2024
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