Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2019022975 | MO |
N | 1223D0001X | Dental Public Health | 2019022975 | MO |
NPI | 1689236176 |
---|---|
Provider Name | Dr. Aldrin Aquino |
First Address | Saint Louis, MO 63104-2560 |
Second Address | Hillsboro, MO 63050-5100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2019 |
Last Update Date | 03/07/2019 |