Individual
MARK MOAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1032 RONDALE CT, O FALLON, MO 63368-7368
(636) 949-2587
Mailing address
51 SAYBRIDGE MANOR PKWY, LAKE SAINT LOUIS, MO 63367-1806
(636) 949-2587
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2000161564
MO
Other
Enumeration date
08/11/2006
Last updated
07/08/2007
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