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General NPI Number Information
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NPI Number | 1174775407
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Entity Type | Organization
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Legal Business Name | GREGORY S. ST. JOHN, DDS, PC
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Dates
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Enumeration Date | 10/17/2008
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Last Update Date | 10/17/2008
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Provider Practice Location Address
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Address Line | 16429 VILLAGE PLAZA VIEW DR
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City | WILDWOOD
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State | MO
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Zip | 63011-4913
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Country | US
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Telephone | 636-458-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 16429 VILLAGE PLAZA VIEW DR
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City | WILDWOOD
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State | MO
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Zip | 63011-4913
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Country | US
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Telephone | 636-458-9300
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREGORY S ST. JOHN
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Credential | DDS
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Telephone | 636-458-9300
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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 | 014718
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License Number State | MO
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