Organization
BOULEVARD DENTAL CARE L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL CRAIG REYES D.M.D. (MANAGER)
(636) 939-6868
Entity
Organization
Contact information
Practice address
2645 MUEGGE RD, SAINT CHARLES, MO 63303-3145
(636) 939-6868
(636) 447-3611
Mailing address
11939 MANCHESTER RD, #120, DES PERES, MO 63131-4502
(636) 939-6868
(636) 447-3611
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
01/07/2007
Last updated
07/30/2007
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