=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982750923
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JASON OBERKFELL, D.D.S., LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1301 YMCA DR SUITE 300
-----------------------------------------------------
City | FESTUS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63028-2655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-993-7656
-----------------------------------------------------
Fax | 636-933-6034
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1301 YMCA DR SUITE 300
-----------------------------------------------------
City | FESTUS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63028-2655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-993-7656
-----------------------------------------------------
Fax | 636-933-6034
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | SANDY MESCHEDE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 636-937-6565
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 016102
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------