Healthcare Provider Details

I. General information

NPI: 1477728335
Provider Name (Legal Business Name): COMPRENHENSIVE FAMILY DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 04/29/2008
Certification Date:
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: 636-447-5764
Mailing address:
  • Phone: 636-447-4080
  • Fax: 636-447-5764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number114202
License Number StateMO

VIII. Authorized Official

Name: MISS CAROL L SCHNEIDER
Title or Position: OFFICE MANAGER
Credential:
Phone: 636-447-4080