MEDICARE: TUAN THAI DMD

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	2019024063	MO

General Provider Information

NPI Number	:	1073175790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TUAN THAI DMD

Provider Business Mailing Address
First Line	:	4910 W PINE BLVD APT 511
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1989
Country	:	US
Telephone Number	:	415-846-0684
Fax Number	:

Provider Business Practice Location Address
First Line	:	12221 SAINT CHARLES ROCK RD
Second Line	:
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2502
Country	:	US
Telephone Number	:	314-656-6615
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2019
Last Update Date	:	07/02/2019

Similar Medicare Providers

1013845999 — JUHI HETAL DESAI
Practice Location Address:

12221 SAINT CHARLES ROCK RD
BRIDGETON, MO
63044-2502

Practice Phone: 314-784-9702
Practice Fax:

1891051421 — JESSICA KENT PHARM D.
Practice Location Address:

12293 SAINT CHARLES ROCK RD
BRIDGETON, MO
63044-2502

Practice Phone: 314-209-5300
Practice Fax:

1528572435 — HERBST DMD LLC
Practice Location Address:

12221 SAINT CHARLES ROCK RD
BRIDGETON, MO
63044-2502

Practice Phone: 314-656-6615
Practice Fax:

1598262263 — DR. MICHAEL J SMOLJAN DDS, MS
Practice Location Address:

12221 SAINT CHARLES ROCK RD
BRIDGETON, MO
63044-2502

Practice Phone: 314-656-6615
Practice Fax:

1356965289 — DR. ESPIR J ABAJI DDS
Practice Location Address:

12221 SAINT CHARLES ROCK RD
BRIDGETON, MO
63044-2502

Practice Phone: 314-656-6615
Practice Fax:

1629705058 — LUXOTTICA OF AMERICA INC
Practice Location Address:

12275 SAINT CHARLES ROCK RD
BRIDGETON, MO
63044-2502

Practice Phone: 314-817-3501
Practice Fax:

Directions to “ TUAN THAI DMD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.