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General NPI Number Information
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NPI Number | 1194954891
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Entity Type | Organization
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Legal Business Name | MISSOURI DENTAL PROFESSIONALS, RICHARD STRAUS, DMD, PC
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 04/25/2018
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Provider Practice Location Address
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Address Line | 100 PIPER HILL DR
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City | SAINT PETERS
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State | MO
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Zip | 63376-1616
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Country | US
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Telephone | 636-477-1000
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Fax | 636-477-8962
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Provider Business Mailing Address
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Address Line | 100 PIPER HILL DR
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City | SAINT PETERS
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State | MO
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Zip | 63376-1616
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Country | US
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Telephone | 636-477-1000
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Fax | 636-477-8962
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Authorized Official
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Title or Position | CREDENTIALING TEAM LEAD
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Name | KENDRA WALKER
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Credential |
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Telephone | 217-540-8513
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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 | 014764
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License Number State | MO
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