Healthcare Provider Details

I. General information

NPI: 1174157788
Provider Name (Legal Business Name): UNIVERSITY CITY ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7171 DELMAR BLVD STE 201
SAINT LOUIS MO
63130-4334
US

IV. Provider business mailing address

7171 DELMAR BLVD STE 201
SAINT LOUIS MO
63130-4334
US

V. Phone/Fax

Practice location:
  • Phone: 314-721-5551
  • Fax:
Mailing address:
  • Phone: 314-721-5551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: REBECCA SCHREINER
Title or Position: ORTHODONTIST
Credential: DDS
Phone: 314-721-5551