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General NPI Number Information
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NPI Number | 1477728335
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Entity Type | Organization
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Legal Business Name | COMPRENHENSIVE FAMILY DENTAL, LLC
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 4125 MEXICO RD
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City | SAINT PETERS
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State | MO
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Zip | 63376-6410
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Country | US
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Telephone | 636-447-4080
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Fax | 636-447-5764
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Provider Business Mailing Address
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Address Line | 4125 MEXICO RD
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City | SAINT PETERS
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State | MO
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Zip | 63376-6410
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Country | US
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Telephone | 636-447-4080
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Fax | 636-447-5764
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS CAROL L SCHNEIDER
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Credential |
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Telephone | 636-447-4080
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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 | 114202
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License Number State | MO
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