Healthcare Provider Details

I. General information

NPI: 1922671163
Provider Name (Legal Business Name): MICHAEL F GRASSO DDS & ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WEST DR STE 120
CHESTERFIELD MO
63017-1843
US

IV. Provider business mailing address

2 WEST DR STE 120
CHESTERFIELD MO
63017-1843
US

V. Phone/Fax

Practice location:
  • Phone: 636-777-7700
  • Fax:
Mailing address:
  • Phone: 636-777-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code122400000X
TaxonomyDenturist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL GRASSO
Title or Position: DOCTOR
Credential: DDS
Phone: 636-777-7700