Healthcare Provider Details

I. General information

NPI: 1558966796
Provider Name (Legal Business Name): DENTAL PROFESSIONALS OF MISSOURI, RICHARD STRAUS, D.M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 S MAIN ST
GRAVOIS MILLS MO
65037-6196
US

IV. Provider business mailing address

128 S MAIN ST
GRAVOIS MILLS MO
65037-6196
US

V. Phone/Fax

Practice location:
  • Phone: 573-374-5739
  • Fax:
Mailing address:
  • Phone:
  • 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: JESSICA BRITT
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 217-540-8426