Healthcare Provider Details

I. General information

NPI: 1477751444
Provider Name (Legal Business Name): CHIH-YI LI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 JEFFERSON ST
SAINT CHARLES MO
63301-2764
US

IV. Provider business mailing address

14543 GREENCASTLE DR
CHESTERFIELD MO
63017-8110
US

V. Phone/Fax

Practice location:
  • Phone: 636-946-3007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2003012139
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: