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General NPI Number Information
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NPI Number | 1427927565
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Entity Type | Organization
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Legal Business Name | WENTZVILLE PEDIATRIC DENTISTRY, LLC
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Dates
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Enumeration Date | 11/04/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 1008 SCHROEDER CREEK BLVD
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City | WENTZVILLE
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State | MO
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Zip | 63385-3558
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Country | US
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Telephone | 901-412-7118
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Fax |
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Provider Business Mailing Address
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Address Line | 1008 SCHROEDER CREEK BLVD
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City | WENTZVILLE
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State | MO
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Zip | 63385-3558
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT HINTZE
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Credential |
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Telephone | 901-412-7118
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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 |
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License Number State |
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