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General NPI Number Information
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NPI Number | 1558544155
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Entity Type | Organization
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Legal Business Name | DENNIS SENDEROVICH D.D.S., P.C.
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Dates
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Enumeration Date | 12/06/2007
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Last Update Date | 12/06/2007
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Provider Practice Location Address
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Address Line | 9979 WINGHAVEN BLVD STE 202
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City | O FALLON
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State | MO
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Zip | 63368-3628
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Country | US
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Telephone | 636-561-7072
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Fax |
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Provider Business Mailing Address
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Address Line | 9979 WINGHAVEN BLVD STE 202
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City | O FALLON
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State | MO
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Zip | 63368-3628
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Country | US
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Telephone | 636-561-7072
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DENNIS SENDEROVICH
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Credential | DDS
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Telephone | 636-561-7072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2002011686
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License Number State | MO
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