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General NPI Number Information
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NPI Number | 1023753241
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Entity Type | Organization
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Legal Business Name | GARDEN HEIGHTS LLC
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Dates
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Enumeration Date | 05/02/2022
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Last Update Date | 05/02/2022
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Provider Practice Location Address
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Address Line | 1608 S BIG BEND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63117-2208
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Country | US
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Telephone | 314-645-1225
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Fax |
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Provider Business Mailing Address
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Address Line | 1710 GRATZ BROWN ST
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City | MOBERLY
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State | MO
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Zip | 65270-1913
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Country | US
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Telephone | 636-443-5205
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Fax | 573-615-0793
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Authorized Official
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Title or Position | CO OWNER
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Name | DR. JOHN OLOUGHLIN
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Credential | DMD
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Telephone | 636-443-5205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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