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General NPI Number Information
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NPI Number | 1225240856
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Entity Type | Individual
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Provider Name | VIDESH DAMODAR DESHMUKH D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 300 CHESTERFIELD CTR SIUTE # 160
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City | CHESTERFIELD
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State | MO
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Zip | 63017-4867
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Country | US
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Telephone | 636-530-7335
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Fax | 636-530-7381
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Provider Business Mailing Address
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Address Line | 15219 NOONING TREE CT
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City | CHESTERFIELD
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State | MO
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Zip | 63017-4401
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Country | US
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Telephone | 636-532-2418
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Fax | 636-530-7381
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 015495
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License Number State | MO
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