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General NPI Number Information
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NPI Number | 1356413611
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Entity Type | Organization
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Legal Business Name | DEMKO ORTHODONTICS LLC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14377 WOODLAKE DR STE 216
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City | CHESTERFIELD
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State | MO
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Zip | 63017
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Country | US
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Telephone | 314-576-4955
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Fax | 314-576-3811
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Provider Business Mailing Address
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Address Line | 14377 WOODLAKE DRIVE STE 216
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City | CHESTERFIELD
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State | MO
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Zip | 63017
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Country | US
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Telephone | 314-576-4955
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Fax | 314-576-3811
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. JAQUELINE ANNE DEMKO
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Credential |
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Telephone | 314-576-4955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 015993
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License Number State | MO
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