Healthcare Provider Details

I. General information

NPI: 1336280841
Provider Name (Legal Business Name): LIFETIME DENTAL CARE OF MISSOURI, RICHARD STRAUS, D.M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 OLD BALLAS RD SUITE 118
SAINT LOUIS MO
63141
US

IV. Provider business mailing address

605 OLD BALLAS RD SUITE 118
SAINT LOUIS MO
63141
US

V. Phone/Fax

Practice location:
  • Phone: 314-993-5310
  • Fax: 314-993-5936
Mailing address:
  • Phone: 314-993-5310
  • Fax: 314-993-5936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CELIA HAYES
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 217-540-2100