| Organization Name: | ELM DENTAL CARE, LLC |
| NPI Number: | 1023258936 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL R LEUCHTMANN (OWNER) |
| Mailing Address: | 3820 Elm St Saint Charles |
| State: | MO US |
| Postal Code: | 633014368 |
| Phone Number: | 6369164848 |
| Fax Number: | 6369161004 |
| NPI Enumeration Date: | 03/05/2009 |
| NPI Last Update Date: | 06/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 2010021038 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |