Healthcare Provider Details

I. General information

NPI: 1013104736
Provider Name (Legal Business Name): LAWRENCE GAYDOS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12101 TESSON FERRY PROFESSIONAL CTR
SAINT LOUIS MO
63128-1250
US

IV. Provider business mailing address

12101 TESSON FERRY PROFESSIONAL CTR
SAINT LOUIS MO
63128-1250
US

V. Phone/Fax

Practice location:
  • Phone: 314-842-1465
  • Fax: 314-842-6964
Mailing address:
  • Phone: 314-842-1465
  • Fax: 314-842-6964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: