Organization
MYSTLDENTIST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM EDWARD UTHOFF DMD (SOLE MEMEBER)
(314) 842-0440
Entity
Organization
Contact information
Practice address
4590 S LINDBERGH BLVD, SAINT LOUIS, MO 63127-1832
(314) 842-0440
(314) 849-5847
Mailing address
4590 S LINDBERGH BLVD, SAINT LOUIS, MO 63127-1832
(314) 842-0440
(314) 848-5847
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
013578
MO
Other
Enumeration date
05/02/2017
Last updated
05/02/2017
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