MEDICARE: SHELLY L. SARICH DDS,MS AND SPENCER ELMORE DDS, MS, PC

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	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1720412463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELLY L. SARICH DDS,MS AND SPENCER ELMORE DDS, MS, PC

Provider Business Mailing Address
First Line	:	1053 RONDALE CT
Second Line	:
City	:	DARDENNE PRAIRIE
State	:	MO
Zip	:	63368-7368
Country	:	US
Telephone Number	:	636-379-4500
Fax Number	:	636-272-4551

Provider Business Practice Location Address
First Line	:	1053 RONDALE CT
Second Line	:
City	:	DARDENNE PRAIRIE
State	:	MO
Zip	:	63368-7368
Country	:	US
Telephone Number	:	636-379-4500
Fax Number	:	636-272-4551

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHELLY L SARICH
Credential	:	DDS
Telephone Number	:	636-379-4500

Provider Enumeration Date	:	08/29/2013
Last Update Date	:	08/29/2013

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