Healthcare Provider Details

I. General information

NPI: 1649323403
Provider Name (Legal Business Name): JONATHAN J MAJERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 MANCHESTER RD
SAINT LOUIS MO
63131-4620
US

IV. Provider business mailing address

11801 MANCHESTER RD
SAINT LOUIS MO
63131-4620
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-8888
  • Fax: 314-821-5488
Mailing address:
  • Phone: 314-821-8888
  • Fax: 314-821-5488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13713
License Number StateMO

VIII. Authorized Official

Name: DR. JONATHAN J MAJERS
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 314-821-8888