Organization
MIDWEST MOBILE DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY GORDON GRAHAM DDS (OWNER/CEO)
(225) 287-8765
Entity
Organization
Contact information
Practice address
1 N BRENTWOOD BLVD STE 1000, SAINT LOUIS, MO 63105-3937
(225) 287-8765
(615) 225-8915
Mailing address
1 NORTH BRENTWOOD BOULEVARD, SUITE 1000, ST LOUIS, MO 63105
(225) 287-8765
(615) 225-8915
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
MO
Other
Enumeration date
06/26/2017
Last updated
07/21/2022
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