Healthcare Provider Details

I. General information

NPI: 1376580118
Provider Name (Legal Business Name): STEVEN T VENNARD D.D,S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17300 N OUTER 40 SUITE 103
CHESTERFIELD MO
63005-1361
US

IV. Provider business mailing address

17300 N OUTER 40 SUITE 103
CHESTERFIELD MO
63005-1361
US

V. Phone/Fax

Practice location:
  • Phone: 636-536-5158
  • Fax: 636-536-4544
Mailing address:
  • Phone: 636-536-5158
  • Fax: 636-536-4544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number2005024545
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: