Healthcare Provider Details

I. General information

NPI: 1275731895
Provider Name (Legal Business Name): RISHAD SHAIKH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2747 W CLAY ST STE B
SAINT CHARLES MO
63301-2557
US

IV. Provider business mailing address

621 S NEW BALLAS RD STE 16A
SAINT LOUIS MO
63141-8239
US

V. Phone/Fax

Practice location:
  • Phone: 636-594-6725
  • Fax:
Mailing address:
  • Phone: 314-251-6725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number30-021959
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2011010943
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: