Healthcare Provider Details

I. General information

NPI: 1730885393
Provider Name (Legal Business Name): DENTAL PROFESSIONALS, RICHARD STRAUS, D.M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 OLD BALLAS RD STE 130
CREVE COEUR MO
63141-7070
US

IV. Provider business mailing address

605 OLD BALLAS RD STE 130
CREVE COEUR MO
63141-7070
US

V. Phone/Fax

Practice location:
  • Phone: 314-256-2135
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HILLARY THULL
Title or Position: CREDENTIALING COORDIANTOR
Credential:
Phone: 217-540-8946