MEDICARE: EUGENIA KARDARIS

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	015560	MO

General Provider Information

NPI Number	:	1588725170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EUGENIA KARDARIS

Provider Business Mailing Address
First Line	:	125 CHESTERFIELD BUSINESS PKWY
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63005-1233
Country	:	US
Telephone Number	:	636-449-0215
Fax Number	:	636-449-1517

Provider Business Practice Location Address
First Line	:	125 CHESTERFIELD BUSINESS PKWY
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63005-1233
Country	:	US
Telephone Number	:	636-449-0215
Fax Number	:	636-449-1517

Authorized Official
Title or Position	:	OWNER
Name	:	EUGENIA KARDARIS II
Credential	:	D.D.S.
Telephone Number	:	636-449-0215

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/01/2008

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