Healthcare Provider Details

I. General information

NPI: 1205946787
Provider Name (Legal Business Name): ORAL AND MAXILLOFACIAL SURGEONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 N NEW BALLAS RD SUITE 249
CREVE COEUR MO
63141-6831
US

IV. Provider business mailing address

456 N NEW BALLAS RD SUITE 249
CREVE COEUR MO
63141-6831
US

V. Phone/Fax

Practice location:
  • Phone: 314-569-2201
  • Fax: 314-569-2320
Mailing address:
  • Phone: 314-569-2201
  • Fax: 314-569-2320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number13560
License Number StateMO

VIII. Authorized Official

Name: DR. KENNETH E KRAM
Title or Position: ORAL SURGEON
Credential: DMD
Phone: 314-569-2201