Organization
CHILDREN'S DENTAL ZONE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CANDACE THERESE WAKEFIELD DMD (OWNER)
(314) 830-9663
Entity
Organization
Contact information
Practice address
13410 NEW HALLS FERRY RD, FLORISSANT, MO 63033-3035
(314) 830-9663
(314) 830-9664
Mailing address
13410 NEW HALLS FERRY RD, FLORISSANT, MO 63033-3035
(314) 830-9663
(314) 830-9664
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
2000175293
MO
Other
Enumeration date
06/27/2011
Last updated
06/27/2011
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