Healthcare Provider Details

I. General information

NPI: 1912377581
Provider Name (Legal Business Name): WALDE FIRTH ORTHODONTIC SPECIALISTS LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 HERITAGE HILLS DRIVE
WASHINGTON MO
63090
US

IV. Provider business mailing address

1507 HERITAGE HILLS DRIVE
WASHINGTON MO
63090
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-5151
  • Fax: 636-390-2728
Mailing address:
  • Phone: 636-239-5151
  • Fax: 636-390-2728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CAROL STEUBER
Title or Position: OFFICE MANAGER
Credential:
Phone: 636-239-5151