Healthcare Provider Details

I. General information

NPI: 1154192300
Provider Name (Legal Business Name): ARCHANA (GAURI) BADARKHE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PARK AVE
SAINT LOUIS MO
63104-3024
US

IV. Provider business mailing address

1270 STRASSNER DR UNIT 3410
SAINT LOUIS MO
63144-1888
US

V. Phone/Fax

Practice location:
  • Phone: 314-833-2700
  • Fax:
Mailing address:
  • Phone: 785-292-9495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2025015892
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: