Healthcare Provider Details

I. General information

NPI: 1053467746
Provider Name (Legal Business Name): ST. LOUIS UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 RUTGER ST
SAINT LOUIS MO
63104-1122
US

IV. Provider business mailing address

3320 RUTGER ST ROOM 2048
SAINT LOUIS MO
63104-1122
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-8363
  • Fax: 314-977-8617
Mailing address:
  • Phone: 314-977-8363
  • Fax: 314-977-8617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROLF G BEHRENTS
Title or Position: CADE EXECUTIVE DIRECTOR
Credential: DDS, MS, PHD
Phone: 314-977-8600