Individual
MARIAH IMANI PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4121 ELM PARK DR, SAINT LOUIS, MO 63128-1918
(314) 845-2730
Mailing address
5926 CATES AVE, SAINT LOUIS, MO 63112-2011
(314) 308-1027
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2018028108
MO
Other
Enumeration date
09/07/2018
Last updated
09/07/2018
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