Healthcare Provider Details

I. General information

NPI: 1013518026
Provider Name (Legal Business Name): DARDENNE DENTAL ARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

7124 S OUTER 364
O FALLON MO
63368-7756
US

IV. Provider business mailing address

7124 S OUTER 364
O FALLON MO
63368-7756
US

V. Phone/Fax

Practice location:
  • Phone: 636-978-4848
  • Fax: 636-978-4862
Mailing address:
  • Phone: 636-978-4848
  • Fax: 636-978-4862

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: DR. MATTHEW EDWARD REYERING
Title or Position: OWNER
Credential: DDS
Phone: 636-978-4848