St Louis Dental Implant Group

NPI #1447424668 in Shiloh, Illinois

Provider Information

NPI Number: 1447424668
Entity Type: Organization
Organization Name: St Louis Dental Implant Group
Primary Specialty: Dentist
Enumeration Date: Apr 18, 2008
Last Updated: Apr 18, 2008

Practice Location

Address: 3750 GREEN MOUNT CROSSING DR
City: Shiloh
State: Illinois
ZIP Code: 62269
Phone: (314) 729-7840

Authorized Official

Name: DR. MARK ALAN MANGELS, DMD
Title: OWNER
Phone: (636) 970-0295

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - Periodontics — Periodontics	1223P0300X
Dentist	122300000X	Primary

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