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General NPI Number Information
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NPI Number | 1013190875
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Entity Type | Organization
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Legal Business Name | MICHAEL AND ANGELA PERNOUD, DDS, PC
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Dates
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Enumeration Date | 12/14/2007
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Last Update Date | 12/14/2007
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Provider Practice Location Address
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Address Line | 8631 HIGHWAY N
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City | LAKE ST. LOUIS
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State | MO
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Zip | 63367
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Country | US
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Telephone | 636-561-4540
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Fax | 636-561-4601
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Provider Business Mailing Address
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Address Line | 8631 HIGHWAY N
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City | LAKE ST. LOUIS
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State | MO
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Zip | 63367
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Country | US
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Telephone | 636-561-4540
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Fax | 636-561-4601
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. ANGELA K PERNOUD
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Credential | DDS
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Telephone | 636-561-4540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2006021264
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License Number State | MO
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