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General NPI Number Information
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NPI Number | 1104932854
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Entity Type | Individual
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Provider Name | GEORGE THOMAS SHUERT D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12277 DE PAUL DR STE 300
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City | BRIDGETON
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State | MO
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Zip | 63044-2529
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Country | US
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Telephone | 314-291-3810
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Fax | 314-291-3816
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Provider Business Mailing Address
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Address Line | 2992 HIGHWAY K
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City | O FALLON
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State | MO
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Zip | 63368-7861
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Country | US
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Telephone | 636-978-6967
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Fax | 636-978-5905
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 011813
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License Number State | MO
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