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General NPI Number Information
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NPI Number | 1447703590
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Entity Type | Organization
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Legal Business Name | ST. LOUIS COUNTY DENTAL PARTNERSHIP, TIMOTHY M GRAYEM DDS & ASSOCIATES
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Dates
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Enumeration Date | 07/25/2016
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Last Update Date | 07/25/2016
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Provider Practice Location Address
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Address Line | 469 S KIRKWOOD RD
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City | KIRKWOOD
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State | MO
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Zip | 63122-6119
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Country | US
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Telephone | 314-965-6503
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Fax | 314-965-7417
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Provider Business Mailing Address
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Address Line | 469 S KIRKWOOD RD
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City | KIRKWOOD
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State | MO
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Zip | 63122-6119
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Country | US
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Telephone | 314-965-6503
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Fax | 314-965-7417
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | JANICE E PELLEY
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Credential |
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Telephone | 314-965-6503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2002013144
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License Number State | MO
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