Healthcare Provider Details

I. General information

NPI: 1629282520
Provider Name (Legal Business Name): JAMES FRANKLIN WILLBRAND DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 MEXICO RD SUITE O
SAINT PETERS MO
63376-6414
US

IV. Provider business mailing address

4101 MEXICO RD SUITE O
SAINT PETERS MO
63376-6414
US

V. Phone/Fax

Practice location:
  • Phone: 636-928-8286
  • Fax: 636-447-7012
Mailing address:
  • Phone: 636-928-8286
  • Fax: 636-447-7012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number013955
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: