Healthcare Provider Details

I. General information

NPI: 1760826291
Provider Name (Legal Business Name): F. JAY OHMES DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 RONDALE CT
DARDENNE PRAIRIE MO
63368-7368
US

IV. Provider business mailing address

1009 RONDALE CT
DARDENNE PRAIRIE MO
63368-7368
US

V. Phone/Fax

Practice location:
  • Phone: 636-978-0226
  • Fax:
Mailing address:
  • Phone: 636-978-0226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE015092
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberDE015092
License Number StateMO

VIII. Authorized Official

Name: DR. F JAY OHMES
Title or Position: OWNER
Credential: DDS
Phone: 636-978-0226