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General NPI Number Information
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NPI Number | 1053862961
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Entity Type | Organization
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Legal Business Name | BEST CARE DENTAL
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 310 E ELM ST
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City | O FALLON
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State | MO
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Zip | 63366-2606
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Country | US
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Telephone | 636-240-6858
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Fax | 636-272-4278
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Provider Business Mailing Address
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Address Line | 310 E ELM ST
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City | O FALLON
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State | MO
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Zip | 63366-2606
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Country | US
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Telephone | 636-240-6858
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Fax | 636-272-4278
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. MARYANA KIROLOS
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Credential | DDS
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Telephone | 636-240-6858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 20125019136
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License Number State | MO
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