MEDICARE: KRISTIANE NAEGLER DMD, 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	015814	MO

General Provider Information

NPI Number	:	1598077927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRISTIANE NAEGLER DMD, LLC

Provider Business Mailing Address
First Line	:	1405 S HANLEY RD STE 100
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-2902
Country	:	US
Telephone Number	:	314-862-2006
Fax Number	:	314-862-2003

Provider Business Practice Location Address
First Line	:	1405 S HANLEY RD STE 100
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-2902
Country	:	US
Telephone Number	:	314-862-2006
Fax Number	:	314-862-2003

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. KRISTIANE M NAEGLER
Credential	:	DMD
Telephone Number	:	314-862-2006

Provider Enumeration Date	:	07/14/2010
Last Update Date	:	05/01/2018

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