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Individual

FADY BOULES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
1600 WENTZVILLE PKWY STE 101, WENTZVILLE, MO 63385-3429
(636) 445-3063
Mailing address
1411 WINDGATE WAY LN, CHESTERFIELD, MO 63005-4496

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2022019939
MO

Other

Enumeration date
06/04/2022
Last updated
06/04/2022
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