MEDICARE: TOWNE CENTRE DENTAL CARE

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	122300000X	Dentist		MO

General Provider Information

NPI Number	:	1053817866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWNE CENTRE DENTAL CARE

Provider Business Mailing Address
First Line	:	132 CHESTERFIELD TOWNE CTR
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63005-1230
Country	:	US
Telephone Number	:	636-733-2363
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 CHESTERFIELD TOWNE CTR
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63005-1230
Country	:	US
Telephone Number	:	636-733-2363
Fax Number	:

Authorized Official
Title or Position	:	REGIONAL SUPPORT SPECIALIST
Name	:	MR. RAYMOND WEBER
Credential	:
Telephone Number	:	314-753-8154

Provider Enumeration Date	:	04/02/2018
Last Update Date	:	04/02/2018

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