Healthcare Provider Details

I. General information

NPI: 1285202531
Provider Name (Legal Business Name): POOJA PINJANI DARA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 02/15/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 DELMAR BLVD
SAINT LOUIS MO
63112-2617
US

IV. Provider business mailing address

2605 N BALLAS RD
SAINT LOUIS MO
63131-3006
US

V. Phone/Fax

Practice location:
  • Phone: 314-477-1891
  • Fax:
Mailing address:
  • Phone: 314-477-1891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number2021026770
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.033174
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: