Healthcare Provider Details

I. General information

NPI: 1639096746
Provider Name (Legal Business Name): DR. KSHITIJA MOHAN NATU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3949 LINDELL BLVD APT 3025
SAINT LOUIS MO
63108-3280
US

IV. Provider business mailing address

3949 LINDELL BLVD APT 4036B
SAINT LOUIS MO
63108-3276
US

V. Phone/Fax

Practice location:
  • Phone: 424-407-5643
  • Fax:
Mailing address:
  • Phone: 424-407-5643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2026030605
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: