Healthcare Provider Details

I. General information

NPI: 1841218807
Provider Name (Legal Business Name): SHELLY LYNN SARICH D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
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:
Title or Position:
Credential:
Phone: