Organization
GIGANTI DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA RAE THEOHAR (OFFICE MANAGER)
(314) 839-2824
Entity
Organization
Contact information
Practice address
317 ELMGROVE AVE, HAZELWOOD, MO 63042-2036
(314) 839-2824
Mailing address
317 ELMGROVE AVE, HAZELWOOD, MO 63042-2036
(314) 839-2824
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2011027046
MO
Other
Enumeration date
04/15/2014
Last updated
04/15/2014
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