Healthcare Provider Details

I. General information

NPI: 1336118728
Provider Name (Legal Business Name): ROBERT RICHARD SCHLUETER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9914 KENNERLY RD
ST LOUIS MO
63128
US

IV. Provider business mailing address

9914 KENNERLY RD
ST LOUIS MO
63128
US

V. Phone/Fax

Practice location:
  • Phone: 314-842-6151
  • Fax: 314-842-6421
Mailing address:
  • Phone: 314-842-6151
  • Fax: 314-842-6421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number011768
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: