MEDICARE: MISSOURI DENTAL PROFESSIONALS, RICHARD STRAUS, D.M.D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1023613163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSOURI DENTAL PROFESSIONALS, RICHARD STRAUS, D.M.D., P.C.

Provider Business Mailing Address
First Line	:	1544 SIERRA VISTA PLZ
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63138-2040
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1544 SIERRA VISTA PLZ
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63138-2040
Country	:	US
Telephone Number	:	314-355-5700
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	TABATHA LEMKE
Credential	:
Telephone Number	:	217-540-6078

Provider Enumeration Date	:	12/04/2020
Last Update Date	:	12/04/2020

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