Organization
GREGORY J POWELL DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GREGORY J POWELL DMD (PRESIDENT)
(314) 298-0727
Entity
Organization
Contact information
Practice address
12255 DEPAUL DRIVE, STE 885, BRIDGETON, MO 63044
(314) 298-0727
Mailing address
12255 DEPAUL DRIVE, STE 885, BRIDGETON, MO 63044
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
12148
MO
Other
Enumeration date
09/09/2010
Last updated
09/09/2010
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