Healthcare Provider Details

I. General information

NPI: 1801140272
Provider Name (Legal Business Name): STEVEN C. MONROTUS, D.M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 MAPLE STREET
FARMINGTON MO
63640
US

IV. Provider business mailing address

603 MAPLE STREET
FARMINGTON MO
63640
US

V. Phone/Fax

Practice location:
  • Phone: 573-756-7500
  • Fax: 573-756-7500
Mailing address:
  • Phone: 573-756-7500
  • Fax: 573-756-7500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE012261
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN CAINE MONROTUS
Title or Position: OWNER
Credential: D.M.D.
Phone: 573-756-7500