Healthcare Provider Details

I. General information

NPI: 1437367000
Provider Name (Legal Business Name): SHELLY L. SARICH D.D.S., M.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1053 RONDALE COURT
DARDENNE PRAIRIE MO
63368
US

IV. Provider business mailing address

1053 RONDALE COURT
DARDENNE PRAIRIE MO
63368
US

V. Phone/Fax

Practice location:
  • Phone: 636-379-4500
  • Fax: 636-272-4551
Mailing address:
  • Phone: 636-379-4500
  • Fax: 636-272-4551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2000154623
License Number StateMO

VIII. Authorized Official

Name: MRS. AMY LYNN COLEMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 636-379-4500