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General NPI Number Information
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NPI Number | 1447419684
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Entity Type | Organization
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Legal Business Name | HEBERT DMD, BROWN DMD & ASSOCIATES, LLC, DBA LIFESMILE DENTAL CARE
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Dates
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Enumeration Date | 06/03/2008
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 8430 PERSHALL RD
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City | HAZELWOOD
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State | MO
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Zip | 63042-3075
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Country | US
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Telephone | 314-521-5678
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Fax | 314-521-0283
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Provider Business Mailing Address
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Address Line | PO BOX 487
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City | HAZELWOOD
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State | MO
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Zip | 63042-0487
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Country | US
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Telephone | 314-521-5678
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Fax | 314-521-0283
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SALLY K HEBERT
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Credential | DMD
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Telephone | 314-521-5678
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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 | DE013034
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License Number State | MO
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