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NPI Code Detail

MEDICARE: DR. DUANE A DILWORTH DDS

MEDICARE: DR. DUANE A DILWORTH DDS
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
11223D0001XPublic Health Dentistry014675MO
21223G0001XGeneral Practice Dentistry014675MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1014675OTHERMOMO LICENSEE

General Provider Information

NPI Number : 1427221688
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DUANE A DILWORTH DDS
Provider Business Mailing Address
First Line : 6121 N HANLEY RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63134-2003
Country : US
Telephone Number : 314-615-0877
Fax Number : 314-615-8303
Provider Business Practice Location Address
First Line : 6121 N HANLEY RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63134-2003
Country : US
Telephone Number : 314-615-0877
Fax Number : 314-615-8303
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2008
Last Update Date : 03/04/2013

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