Healthcare Provider Details

I. General information

NPI: 1447439716
Provider Name (Legal Business Name): GEORGE D BANKHEAD DDS MS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3890 S LINDBERGH BLVD SUITE 115
SUNSET HILLS MO
63127
US

IV. Provider business mailing address

3890 S LINDBERGH BLVD SUITE 115
SUNSET HILLS MO
63127
US

V. Phone/Fax

Practice location:
  • Phone: 314-843-5553
  • Fax: 314-849-6764
Mailing address:
  • Phone: 314-843-5553
  • Fax: 314-849-6764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number015576
License Number StateMO

VIII. Authorized Official

Name: DR. JOHN R FIRTH
Title or Position: PRESIDENT
Credential: DDS MS
Phone: 314-843-5553