Healthcare Provider Details

I. General information

NPI: 1366657405
Provider Name (Legal Business Name): STEVEN J. HRIBERNIK, D.M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 E GANNON DR
FESTUS MO
63028-2611
US

IV. Provider business mailing address

1155 E GANNON DR
FESTUS MO
63028-2611
US

V. Phone/Fax

Practice location:
  • Phone: 636-931-4699
  • Fax: 636-931-5110
Mailing address:
  • Phone: 636-931-4699
  • Fax: 636-931-5110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number015277
License Number StateMO

VIII. Authorized Official

Name: MS. PEGGY S. CAROTHERS
Title or Position: OFFICE MANAGER
Credential:
Phone: 314-842-4699