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General NPI Number Information
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NPI Number | 1629366760
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Entity Type | Organization
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Legal Business Name | ST. LOUIS PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 07/11/2011
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Last Update Date | 07/11/2011
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Provider Practice Location Address
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Address Line | 4142 KEATON CROSSING BLVD SUITE 102
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City | O FALLON
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State | MO
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Zip | 63368-8404
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Country | US
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Telephone | 636-205-4639
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Fax | 314-594-0742
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Provider Business Mailing Address
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Address Line | 4142 KEATON CROSSING BLVD SUITE 102
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City | O FALLON
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State | MO
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Zip | 63368-8404
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Country | US
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Telephone | 636-205-4639
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Fax | 314-594-0742
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Authorized Official
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Title or Position | PEDIATRIC DENTIST/OWNER OF PRACTICE
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Name | DR. LINDSEY CHRISTIAN REED
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Credential | DDS
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Telephone | 636-205-4639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2010006281
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License Number State | MO
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