Healthcare Provider Details

I. General information

NPI: 1699698548
Provider Name (Legal Business Name): VALUDENTAL GRAVOIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5017 GRAVOIS AVE
SAINT LOUIS MO
63116-2307
US

IV. Provider business mailing address

5017 GRAVOIS AVE
SAINT LOUIS MO
63116-2307
US

V. Phone/Fax

Practice location:
  • Phone: 314-768-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: LINDA ESLER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 314-768-0000