Individual
RYAN MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4527 FOREST PARK AVE, SAINT LOUIS, MO 63108-2113
(314) 858-5750
Mailing address
4527 FOREST PARK AVE, SAINT LOUIS, MO 63108-2113
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2020008459
MO
1223G0001X
General Practice Dentistry
Primary
2020008459
MO
Other
Enumeration date
06/21/2017
Last updated
06/25/2020
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