MEDICARE: DR. STEWART G SACHTLEBEN D.D.S

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	DE015115	MO

General Provider Information

NPI Number	:	1679786222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEWART G SACHTLEBEN D.D.S

Provider Business Mailing Address
First Line	:	2133 PARK FOREST DR
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-5029
Country	:	US
Telephone Number	:	636-519-0077
Fax Number	:

Provider Business Practice Location Address
First Line	:	2315 MCKELVEY RD
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-1531
Country	:	US
Telephone Number	:	314-878-6999
Fax Number	:	314-878-6932

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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