Healthcare Provider Details

I. General information

NPI: 1740279967
Provider Name (Legal Business Name): ERIN MARISCAL D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 RICHARDSON XING
ARNOLD MO
63010-6023
US

IV. Provider business mailing address

124 RICHARDSON XING
ARNOLD MO
63010-6023
US

V. Phone/Fax

Practice location:
  • Phone: 636-464-6444
  • Fax: 636-464-6465
Mailing address:
  • Phone: 636-464-6444
  • Fax: 636-464-6465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2003013103
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2003013103
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: