Healthcare Provider Details

I. General information

NPI: 1457378812
Provider Name (Legal Business Name): TONI ANNETTE GOINS-CRANK D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 S KIRKWOOD RD STE. 205
KIRKWOOD MO
63122-6169
US

IV. Provider business mailing address

472 REDWOOD FOREST DR
BALLWIN MO
63021-5756
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-2400
  • Fax: 314-821-2288
Mailing address:
  • Phone: 314-821-2400
  • Fax: 314-821-2288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDE-015194
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: