Healthcare Provider Details

I. General information

NPI: 1497978282
Provider Name (Legal Business Name): RAYMOND W GELCHION D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 SOUTH HIGHWAY 94
ST. CHARLES MO
63303-5622
US

IV. Provider business mailing address

1536 YARMOUTH POINT DR
CHESTERFIELD MO
63017-5640
US

V. Phone/Fax

Practice location:
  • Phone: 636-928-8400
  • Fax:
Mailing address:
  • Phone: 636-532-3988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number012469
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: