Individual
KENNETH NEAL BROSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2440 S BRENTWOOD BLVD, BRENTWOOD, MO 63144-2320
(314) 962-6643
Mailing address
1233 LAKE VIEW LANE, O'FALLON, IL 62269
(618) 540-5960
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2020017357
MO
Other
Enumeration date
10/05/2023
Last updated
10/05/2023
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