Healthcare Provider Details

I. General information

NPI: 1366805285
Provider Name (Legal Business Name): BAXTER SMILES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201A E 5TH ST
EUREKA MO
63025-1223
US

IV. Provider business mailing address

201A E 5TH ST
EUREKA MO
63025-1223
US

V. Phone/Fax

Practice location:
  • Phone: 636-938-7827
  • Fax:
Mailing address:
  • Phone: 636-938-7827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2009012917
License Number StateMO

VIII. Authorized Official

Name: DR. ADAM T WEHRMEISTER
Title or Position: OWNER
Credential: DDS
Phone: 636-227-9666