Healthcare Provider Details

I. General information

NPI: 1235487653
Provider Name (Legal Business Name): LOUIS J SINDELAR JR DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11225 TESSON FERRY RD
SAINT LOUIS MO
63123-6921
US

IV. Provider business mailing address

11225 TESSON FERRY RD
SAINT LOUIS MO
63123-6921
US

V. Phone/Fax

Practice location:
  • Phone: 314-849-1998
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number13573
License Number StateMO

VIII. Authorized Official

Name: DR. DANIEL SINDELAR
Title or Position: OWNER
Credential: DMD
Phone: 314-849-1998