Individual
NICOLE NIEWDACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
11648 MANCHESTER RD, SAINT LOUIS, MO 63131-4612
(314) 394-2828
Mailing address
11648 MANCHESTER RD, SAINT LOUIS, MO 63131-4612
(314) 394-2828
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2008013576
MO
Other
Enumeration date
05/27/2008
Last updated
06/23/2015
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