Healthcare Provider Details

I. General information

NPI: 1780040998
Provider Name (Legal Business Name): DR. MINAAL VERMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2016
Last Update Date: 03/29/2023
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11816 CRAIG MANOR DR
SAINT LOUIS MO
63146-5496
US

IV. Provider business mailing address

11816 CRAIG MANOR DR
SAINT LOUIS MO
63146-5496
US

V. Phone/Fax

Practice location:
  • Phone: 973-454-7027
  • Fax:
Mailing address:
  • Phone: 973-454-7027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2901021739
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2019000967
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number019032048
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: