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General NPI Number Information
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NPI Number | 1164528659
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Entity Type | Organization
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Legal Business Name | ETHAN J SCHUMAN DMD
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 658 N BALLAS RD
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City | SAINT LOUIS
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State | MO
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Zip | 63122-2151
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Country | US
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Telephone | 314-432-2580
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Fax |
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Provider Business Mailing Address
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Address Line | 658 N BALLAS RD
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City | SAINT LOUIS
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State | MO
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Zip | 63122-2151
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Country | US
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Telephone | 314-432-2580
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JANET WEISBERG
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Credential |
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Telephone | 314-432-2580
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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 |
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License Number State |
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