Healthcare Provider Details

I. General information

NPI: 1841009438
Provider Name (Legal Business Name): PLD OF ST. CHARLES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 CAVE SPRINGS ESTATE DR
SAINT PETERS MO
63376-6529
US

IV. Provider business mailing address

1185 CAVE SPRINGS ESTATE DR
SAINT PETERS MO
63376-6529
US

V. Phone/Fax

Practice location:
  • Phone: 636-757-1800
  • Fax:
Mailing address:
  • Phone: 636-757-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT WELDON THOMPSON III
Title or Position: DENTIST
Credential: DDS
Phone: 314-635-0822