Healthcare Provider Details

I. General information

NPI: 1407943350
Provider Name (Legal Business Name): JAMES L UNGER DMD MS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5913 MEXICO RD
SAINT PETERS MO
63376
US

IV. Provider business mailing address

5913 MEXICO RD
SAINT PETERS MO
63376
US

V. Phone/Fax

Practice location:
  • Phone: 636-939-3777
  • Fax: 636-939-0252
Mailing address:
  • Phone: 636-939-3777
  • Fax: 636-939-0252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number012244
License Number StateMO

VIII. Authorized Official

Name: JAMES L UNGER
Title or Position: PRESIDENT
Credential: DMD MS
Phone: 636-439-3777