Healthcare Provider Details

I. General information

NPI: 1235496597
Provider Name (Legal Business Name): ADIS HASANAGIC D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 TELEGRAPH ROAD
ST. LOUIS MO
63125-5557
US

IV. Provider business mailing address

3130 TELEGRAPH ROAD
ST. LOUIS MO
63125-5557
US

V. Phone/Fax

Practice location:
  • Phone: 314-487-8844
  • Fax: 314-487-8529
Mailing address:
  • Phone: 314-487-8844
  • Fax: 314-487-8529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2011017058
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: