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General NPI Number Information
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NPI Number | 1033295464
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Entity Type | Organization
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Legal Business Name | FAYE E LICATA DMD FAGD PC
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 111 HILLTOWN VILLAGE CENTER SUITE #200
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City | CHESTERFIELD
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State | MO
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Zip | 63017
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Country | US
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Telephone | 636-532-2101
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Fax | 636-532-2209
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Provider Business Mailing Address
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Address Line | 111 HILLTOWN VILLAGE CENTER SUITE #200
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City | CHESTERFIELD
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State | MO
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Zip | 63017
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Country | US
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Telephone | 636-532-2101
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Fax | 636-532-2209
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | DR. FAYE E LICATA
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Credential | DMD
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Telephone | 636-532-2101
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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 | 015059
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License Number State | MO
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