Healthcare Provider Details

I. General information

NPI: 1972570109
Provider Name (Legal Business Name): PATRICK TRAUERNICHT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3608 FARAON ST
SAINT JOSEPH MO
64506-3044
US

IV. Provider business mailing address

3608 FARAON ST
SAINT JOSEPH MO
64506-3044
US

V. Phone/Fax

Practice location:
  • Phone: 816-364-6444
  • Fax: 816-364-6929
Mailing address:
  • Phone: 816-364-6444
  • Fax: 816-364-6929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2005015643
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: