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General NPI Number Information
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NPI Number | 1083106413
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Entity Type | Organization
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Legal Business Name | KRISTIANE NAEGLER DMD, LLC
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Dates
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Enumeration Date | 06/01/2018
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Last Update Date | 06/01/2018
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Provider Practice Location Address
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Address Line | 853 MEDICAL DR STE 114
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City | WENTZVILLE
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State | MO
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Zip | 63385-3823
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Country | US
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Telephone | 636-205-0151
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Fax |
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Provider Business Mailing Address
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Address Line | 853 MEDICAL DR STE 114
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City | WENTZVILLE
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State | MO
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Zip | 63385-3823
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Country | US
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Telephone | 636-205-0151
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KERRI SMITH
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Credential |
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Telephone | 573-424-0236
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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 | 15815
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License Number State | MO
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