Healthcare Provider Details

I. General information

NPI: 1225154677
Provider Name (Legal Business Name): JOHN C G'SELL D.D.S., F.A.G.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 CONCORD PLAZA SHOPPING CTR
SAINT LOUIS MO
63128-1307
US

IV. Provider business mailing address

177 CONCORD PLAZA SHOPPING CTR
SAINT LOUIS MO
63128-1307
US

V. Phone/Fax

Practice location:
  • Phone: 314-849-8888
  • Fax: 314-849-8043
Mailing address:
  • Phone: 314-849-8888
  • Fax: 314-849-8043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13477
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: