Individual
ABBY DETWEILER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4055 LINDELL BLVD, SAINT LOUIS, MO 63108-3201
(314) 535-7701
Mailing address
5701 DELMAR BLVD, SAINT LOUIS, MO 63112-2617
(314) 367-7848
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2019038682
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
400092156
—
MO
Enumeration date
10/07/2019
Last updated
03/28/2022
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