Individual
DR. ANGELINA ANISIMOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
589 MID RIVERS MALL DR, SAINT PETERS, MO 63376-2152
(636) 970-1595
(636) 279-1117
Mailing address
589 MID RIVERS MALL DR, SAINT PETERS, MO 63376-2152
(636) 970-1595
(636) 279-1117
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2003013493
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
408833614
—
MO
Enumeration date
02/05/2007
Last updated
07/08/2007
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