Organization
CHARLES E. NIESEN II, DMD, MICHAEL J. FADDIS, DDS
Active
Other names
Brentwood Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL J. FADDIS DDS (OWNER)
(314) 962-6643
Entity
Organization
Contact information
Practice address
2440 S BRENTWOOD BLVD, SAINT LOUIS, MO 63144-2321
(314) 962-6643
(314) 962-2205
Mailing address
2440 S BRENTWOOD BLVD, SAINT LOUIS, MO 63144-2321
(314) 962-6643
(314) 962-2205
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
12/13/2006
Last updated
08/21/2007
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