Healthcare Provider Details

I. General information

NPI: 1114190220
Provider Name (Legal Business Name): ALLEN SCLAROFF DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ SUITE 16432
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

1040 N MASON SUITE 207
CREVE COEUR MO
63141
US

V. Phone/Fax

Practice location:
  • Phone: 314-361-6006
  • Fax: 314-631-6599
Mailing address:
  • Phone: 314-453-9705
  • Fax: 314-453-9706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number012170
License Number StateMO

VIII. Authorized Official

Name: DR. ALLEN SCLAROFF
Title or Position: OWNER
Credential: DDS
Phone: 314-453-9705