=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437456001
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLAZA HEALTH DENTISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2011
-----------------------------------------------------
Last Update Date | 02/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9420 WATSON RD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63126-1529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-843-0500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9420 WATSON RD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63126-1529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-843-0500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT/DENTIST
-----------------------------------------------------
Name | DR. WILLIAM J SCHLOTZ
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 314-843-0500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | DE015548
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------