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NPI Code Detail

MEDICARE: MR. ROBERT KNOX MASSIE DDS

MEDICARE: MR. ROBERT KNOX MASSIE 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
1122300000XDentist2001005623MO

General Provider Information

NPI Number : 1619961612
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBERT KNOX MASSIE DDS
Provider Business Mailing Address
First Line : 401 HOLLY HILLS AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63111-2410
Country : US
Telephone Number : 314-481-1615
Fax Number : 314-353-1310
Provider Business Practice Location Address
First Line : 401 HOLLY HILLS AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63111-2410
Country : US
Telephone Number : 314-481-1615
Fax Number : 314-353-1310
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2005
Last Update Date : 07/08/2007

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