Healthcare Provider Details

I. General information

NPI: 1912579723
Provider Name (Legal Business Name): MISSOURI DENTAL PROFESSIONALS, RICHARD STRAUS, DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 NW BUCKNER TARSNEY RD
GRAIN VALLEY MO
64029-7876
US

IV. Provider business mailing address

1200 NW BUCKNER TARSNEY RD
GRAIN VALLEY MO
64029-7876
US

V. Phone/Fax

Practice location:
  • Phone: 816-867-4115
  • Fax:
Mailing address:
  • Phone: 816-867-4115
  • 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: CELIA HAYES
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 217-540-2100