MEDICARE: DR. TONI ANNETTE GOINS-CRANK D.D.S., M.S.

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
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DE-015194	MO

General Provider Information

NPI Number	:	1457378812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TONI ANNETTE GOINS-CRANK D.D.S., M.S.

Provider Business Mailing Address
First Line	:	472 REDWOOD FOREST DR
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63021-5756
Country	:	US
Telephone Number	:	314-821-2400
Fax Number	:	314-821-2288

Provider Business Practice Location Address
First Line	:	439 S KIRKWOOD RD
Second Line	:	STE. 205
City	:	KIRKWOOD
State	:	MO
Zip	:	63122-6169
Country	:	US
Telephone Number	:	314-821-2400
Fax Number	:	314-821-2288

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	07/08/2007

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