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General NPI Number Information
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NPI Number | 1043899677
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Entity Type | Organization
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Legal Business Name | RIVER CITY ENDODONTICS
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Dates
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Enumeration Date | 04/02/2021
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Last Update Date | 12/12/2021
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Provider Practice Location Address
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Address Line | 113 CHURCH ST
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City | O FALLON
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State | MO
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Zip | 63366-2894
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Country | US
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Telephone | 636-362-4040
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Fax | 636-362-4141
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Provider Business Mailing Address
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Address Line | 113 CHURCH ST
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City | O FALLON
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State | MO
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Zip | 63366-2894
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Country | US
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Telephone | 636-362-4040
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Fax | 636-362-4141
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW JAMES WALKER
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Credential | D.D.S., M.S.D
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Telephone | 636-362-4040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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