Healthcare Provider Details

I. General information

NPI: 1447536453
Provider Name (Legal Business Name): CIGNODENTAL CARE LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 BELLEFONTAINE
SAINT LOUIS MO
63138
US

IV. Provider business mailing address

12000 BELLEFONTAINE RD
SAINT LOUIS MO
63138-1903
US

V. Phone/Fax

Practice location:
  • Phone: 314-741-5133
  • Fax: 314-741-3161
Mailing address:
  • Phone: 314-741-5133
  • Fax: 314-741-3161

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. SAM E CIGNO
Title or Position: OWNER
Credential: DDS
Phone: 314-741-5133