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General NPI Number Information
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NPI Number | 1730357195
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Entity Type | Organization
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Legal Business Name | DOUGLAS H. REDIGER DDS, PC
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 1010 N TRUMAN BLVD
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City | CRYSTAL CITY
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State | MO
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Zip | 63019-1331
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Country | US
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Telephone | 636-937-1441
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Fax | 636-937-3768
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Provider Business Mailing Address
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Address Line | 3876 VOGEL RD
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City | ARNOLD
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State | MO
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Zip | 63010-3776
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Country | US
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Telephone | 636-282-0550
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Fax | 636-282-1011
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | LAURIE A GERBER
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Credential |
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Telephone | 636-282-0550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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