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1642 Clarkson Rd Chesterfield MO 63017-4601 | |
| (636) 728-1540 | |
| (636) 728-1545 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1642 Clarkson Rd, Chesterfield, Missouri |
| Authorized Official Name and Position | Kendra Walker (CREDENTIALING TEAM LEAD) |
| Authorized Official Contact | 2175408513 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1642 Clarkson Rd Chesterfield MO 63017-4601 Ph: (636) 728-1540 | 1642 Clarkson Rd Chesterfield MO 63017-4601 Ph: (636) 728-1540 |
| NPI Number | 1720370497 |
|---|---|
| Provider Enumeration Date | 05/12/2011 |
| Last Update Date | 04/25/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720370497 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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