Healthcare Provider Details

I. General information

NPI: 1750611844
Provider Name (Legal Business Name): JONATHAN A SHANKER DDS MS & BRIAN A SCHLUETER DMD MS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12111 TESSON FERRY PROFESSIONAL CTR
SAINT LOUIS MO
63128-1250
US

IV. Provider business mailing address

12111 TESSON FERRY PROFESSIONAL CTR
SAINT LOUIS MO
63128-1250
US

V. Phone/Fax

Practice location:
  • Phone: 314-842-4105
  • Fax: 314-842-3580
Mailing address:
  • Phone: 314-842-4105
  • Fax: 314-842-3580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JONATHAN ARTHUR SHANKER
Title or Position: DOCTOR
Credential: DDS
Phone: 314-842-4105