Healthcare Provider Details

I. General information

NPI: 1407749088
Provider Name (Legal Business Name): SKYVIEW PEDIATRIC DENTISTRY-GT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10049 MANCHESTER RD
SAINT LOUIS MO
63122-1825
US

IV. Provider business mailing address

13001 N OUTER 40 RD STE 360
TOWN AND COUNTRY MO
63017-5941
US

V. Phone/Fax

Practice location:
  • Phone: 314-671-4019
  • Fax:
Mailing address:
  • Phone: 314-626-4579
  • Fax:

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: EMILY HAHN
Title or Position: OWNER
Credential: DDS
Phone: 618-210-8323