Organization
WESTPORT DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADAM BIRK D.M.D. (OWNER)
(618) 410-6016
Entity
Organization
Contact information
Practice address
77 W PORT PLZ, SUITE NO. 251, SAINT LOUIS, MO 63146-3107
(618) 410-6016
Mailing address
9873 GRANTVIEW FOREST DR, SAINT LOUIS, MO 63123-3955
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2015020290
MO
Other
Enumeration date
03/26/2017
Last updated
03/26/2017
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