MEDICARE: SCOTT D KLOHR DMD LLC

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	1223G0001X	General Practice Dentistry	2005026032	MO

General Provider Information

NPI Number	:	1932307105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT D KLOHR DMD LLC

Provider Business Mailing Address
First Line	:	1608 S BIG BEND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-2208
Country	:	US
Telephone Number	:	314-645-1225
Fax Number	:	314-645-1327

Provider Business Practice Location Address
First Line	:	1608 S BIG BEND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-2208
Country	:	US
Telephone Number	:	314-645-1225
Fax Number	:	314-645-1327

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. SCOTT DOUGLAS KLOHR
Credential	:	D.M.D.
Telephone Number	:	314-645-1225

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	07/10/2007

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