Healthcare Provider Details

I. General information

NPI: 1255426979
Provider Name (Legal Business Name): TERENCE A. FRISKEL DDS,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N MAIN ST
DE SOTO MO
63020-1709
US

IV. Provider business mailing address

110 N MAIN ST
DE SOTO MO
63020-1709
US

V. Phone/Fax

Practice location:
  • Phone: 636-586-2410
  • Fax:
Mailing address:
  • Phone: 636-586-2410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. TERENCE A. FRISKEL
Title or Position: DENTIST
Credential: DDS
Phone: 636-586-2410