Healthcare Provider Details

I. General information

NPI: 1295656205
Provider Name (Legal Business Name): AL G DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12221 SAINT CHARLES ROCK RD
BRIDGETON MO
63044-2502
US

IV. Provider business mailing address

PO BOX 70887
CLEVELAND OH
44190-0887
US

V. Phone/Fax

Practice location:
  • Phone: 314-656-6615
  • Fax: 314-298-0030
Mailing address:
  • Phone: 315-454-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE BARBER
Title or Position: PROVIDER ENROLLMENT MANAGER
Credential:
Phone: 315-454-6000