MEDICARE: OAKVILLE DENTAL CARE, 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	122300000X	Dentist	2006014778	MO

General Provider Information

NPI Number	:	1770903924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAKVILLE DENTAL CARE, LLC

Provider Business Mailing Address
First Line	:	6076 TELEGRAPH RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-4732
Country	:	US
Telephone Number	:	314-487-0333
Fax Number	:	314-487-0441

Provider Business Practice Location Address
First Line	:	6076 TELEGRAPH RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-4732
Country	:	US
Telephone Number	:	314-487-0333
Fax Number	:	314-487-0441

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KATIE FRANKLIN
Credential	:
Telephone Number	:	314-487-0333

Provider Enumeration Date	:	04/25/2014
Last Update Date	:	04/25/2014

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