Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2020024646 | MO |
NPI | 1003428335 |
---|---|
Provider Name | Ralph Thomas Dinges |
First Address | Saint Louis, MO 63139-1414 |
Second Address | O Fallon, MO 63368-7756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2020 |
Last Update Date | 18/08/2020 |