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2 West Dr Ste 120 Chesterfield MO 63017-1843 | |
| (636) 660-0490 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2 West Dr Ste 120, Chesterfield, Missouri |
| Authorized Official Name and Position | Stephanie Moore (DIRECTOR OF REVENUE CYCLE) |
| Authorized Official Contact | 8327044262 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 8251 Carol Stream IL 60197-8251 Ph: (727) 776-9642 | 2 West Dr Ste 120 Chesterfield MO 63017-1843 Ph: (636) 660-0490 |
| NPI Number | 1699552869 |
|---|---|
| Provider Enumeration Date | 09/12/2023 |
| Last Update Date | 12/11/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699552869 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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