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General NPI Number Information
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NPI Number | 1548401318
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Entity Type | Organization
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Legal Business Name | DARDENNE DENTAL LLC
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Dates
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Enumeration Date | 03/09/2009
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Last Update Date | 03/09/2009
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Provider Practice Location Address
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Address Line | 1654 BRYAN RD
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City | O FALLON
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State | MO
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Zip | 63368-4897
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Country | US
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Telephone | 636-978-4848
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Fax | 636-978-4862
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Provider Business Mailing Address
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Address Line | 1654 BRYAN RD
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City | O FALLON
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State | MO
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Zip | 63368-4897
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Country | US
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Telephone | 636-978-4848
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Fax | 636-978-4862
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Authorized Official
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Title or Position | OWNER
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Name | DR. ARMEN TUMANYAN
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Credential |
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Telephone | 636-978-4848
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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 | 200214199
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License Number State | MO
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