Healthcare Provider Details

I. General information

NPI: 1326061680
Provider Name (Legal Business Name): HOWARD B. SCHWADRON, D.M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 GEORGIA ST
LOUISIANA MO
63353-1613
US

IV. Provider business mailing address

801 GEORGIA ST
LOUISIANA MO
63353-1613
US

V. Phone/Fax

Practice location:
  • Phone: 573-754-4531
  • Fax: 573-754-9806
Mailing address:
  • Phone: 573-754-4531
  • Fax: 573-754-9806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number013057
License Number StateMO

VIII. Authorized Official

Name: DR. HOWARD B. SCHWADRON
Title or Position: OWNER
Credential: D.M.D.
Phone: 573-754-4531