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NPI Code Detail

MEDICARE: DR. JOHN C G'SELL D.D.S., F.A.G.D.

MEDICARE: DR. JOHN C G'SELL D.D.S., F.A.G.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry13477MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1104269OTHERMOFEDERAL BLUE CROSS INS
2106747OTHERMOUNITED CONCORDIA PROVIDER

General Provider Information

NPI Number : 1225154677
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN C G'SELL D.D.S., F.A.G.D.
Provider Business Mailing Address
First Line : 177 CONCORD PLAZA SHOPPING CTR
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63128-1307
Country : US
Telephone Number : 314-849-8888
Fax Number : 314-849-8043
Provider Business Practice Location Address
First Line : 177 CONCORD PLAZA SHOPPING CTR
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63128-1307
Country : US
Telephone Number : 314-849-8888
Fax Number : 314-849-8043
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 07/08/2007

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