Healthcare Provider Details

I. General information

NPI: 1205745734
Provider Name (Legal Business Name): AUGUSTINE J BORGMEYER DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4171 CRESCENT DR STE 102
SAINT LOUIS MO
63129-3645
US

IV. Provider business mailing address

4171 CRESCENT DR STE 102
SAINT LOUIS MO
63129-3645
US

V. Phone/Fax

Practice location:
  • Phone: 314-200-3880
  • Fax: 314-200-3879
Mailing address:
  • Phone: 314-200-3880
  • Fax: 314-200-3879

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: TERRA COTTON
Title or Position: OFFICE MANAGER
Credential: CDA
Phone: 314-265-3597