Healthcare Provider Details

I. General information

NPI: 1538414826
Provider Name (Legal Business Name): ERIN SCIMONE D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4607 HAMPTON AVE
SAINT LOUIS MO
63109-2749
US

IV. Provider business mailing address

4127 EXETER AVE
SAINT LOUIS MO
63119-2132
US

V. Phone/Fax

Practice location:
  • Phone: 314-481-3369
  • Fax:
Mailing address:
  • Phone: 618-558-9978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2012015401
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: