Healthcare Provider Details

I. General information

NPI: 1962943423
Provider Name (Legal Business Name): ANDRE ARTIS JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2017
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 MEXICO RD
SAINT PETERS MO
63376-6410
US

IV. Provider business mailing address

4125 MEXICO RD
SAINT PETERS MO
63376-6410
US

V. Phone/Fax

Practice location:
  • Phone: 636-447-4080
  • Fax:
Mailing address:
  • Phone: 636-447-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number202003447
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: