=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538838479
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SARACINO FAMILY ORTHODONTICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2021
-----------------------------------------------------
Last Update Date | 09/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6555 CHIPPEWA ST STE 200
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63109-4110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-649-8999
-----------------------------------------------------
Fax | 314-649-9001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6555 CHIPPEWA ST STE 200
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63109-4110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-649-8999
-----------------------------------------------------
Fax | 314-649-9001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORTHODONTIST
-----------------------------------------------------
Name | DR. CATHERINE SARACINO
-----------------------------------------------------
Credential | DMD, MS
-----------------------------------------------------
Telephone | 314-649-8999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------