Healthcare Provider Details

I. General information

NPI: 1033042700
Provider Name (Legal Business Name): BRANDON NICHOLAS PAPPAS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3859 GRAVOIS AVE
SAINT LOUIS MO
63116-4657
US

IV. Provider business mailing address

269 BLACKBERRY RIDGE RD
CAPE GIRARDEAU MO
63701-9643
US

V. Phone/Fax

Practice location:
  • Phone: 314-912-3604
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2026023638
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: