MEDICARE: LEMAY FAMILY DENTISTRY LLC

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	2009013225	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558873422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEMAY FAMILY DENTISTRY LLC

Provider Business Mailing Address
First Line	:	727 LEMAY FERRY RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-1427
Country	:	US
Telephone Number	:	314-638-2121
Fax Number	:

Provider Business Practice Location Address
First Line	:	727 LEMAY FERRY RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-1427
Country	:	US
Telephone Number	:	314-638-2121
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AUSTYN LEHMUTH
Credential	:	DDS
Telephone Number	:	314-638-2121

Provider Enumeration Date	:	10/31/2017
Last Update Date	:	10/31/2017

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