MEDICARE: DENTAL PROFESSIONALS, RICHARD STRAUS, D.M.D., P.C.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1730885393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL PROFESSIONALS, RICHARD STRAUS, D.M.D., P.C.

Provider Business Mailing Address
First Line	:	605 OLD BALLAS RD STE 130
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-7070
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 OLD BALLAS RD STE 130
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-7070
Country	:	US
Telephone Number	:	314-256-2135
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING COORDIANTOR
Name	:	HILLARY THULL
Credential	:
Telephone Number	:	217-540-8946

Provider Enumeration Date	:	02/06/2023
Last Update Date	:	02/06/2023

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