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General NPI Number Information
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NPI Number | 1023613163
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Entity Type | Organization
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Legal Business Name | MISSOURI DENTAL PROFESSIONALS, RICHARD STRAUS, D.M.D., P.C.
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Dates
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Enumeration Date | 12/04/2020
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Last Update Date | 12/04/2020
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Provider Practice Location Address
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Address Line | 1544 SIERRA VISTA PLZ
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City | SAINT LOUIS
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State | MO
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Zip | 63138-2040
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Country | US
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Telephone | 314-355-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 1544 SIERRA VISTA PLZ
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City | SAINT LOUIS
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State | MO
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Zip | 63138-2040
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | TABATHA LEMKE
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Credential |
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Telephone | 217-540-6078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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