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NPI Code Detail

MEDICARE: RICHARD W DANYLUCK DMD

MEDICARE: RICHARD W DANYLUCK DMD
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
1122300000XDentist012214MO

General Provider Information

NPI Number : 1588782742
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD W DANYLUCK DMD
Provider Business Mailing Address
First Line : 3940 S BROADWAY
Second Line :
City : ST LOUIS
State : MO
Zip : 63118-4626
Country : US
Telephone Number : 314-776-4700
Fax Number : 314-776-2248
Provider Business Practice Location Address
First Line : 3940 S BROADWAY
Second Line :
City : ST LOUIS
State : MO
Zip : 63118-4626
Country : US
Telephone Number : 314-776-4700
Fax Number : 314-776-2248
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2007
Last Update Date : 07/08/2007

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Directions to “ RICHARD W DANYLUCK DMD” Practice Location

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