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16100 Chesterfield Pkwy W Suite 320 Chesterfield MO 63017-4871 | |
| (636) 532-3208 | |
| (636) 532-1371 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 16100 Chesterfield Pkwy W, Chesterfield, Missouri |
| Authorized Official Name and Position | Charles E Johnson (PRESIDENT) |
| Authorized Official Contact | 6365323208 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
16100 Chesterfield Pkwy W Suite 320 Chesterfield MO 63017-4871 Ph: (636) 532-3208 | 16100 Chesterfield Pkwy W Suite 320 Chesterfield MO 63017-4871 Ph: (636) 532-3208 |
| NPI Number | 1346268224 |
|---|---|
| Provider Enumeration Date | 07/18/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346268224 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 12610 (Missouri) | Primary |
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