MEDICARE: MISSOURI DENTAL PROFESSIONALS, RICHARD STRAUS, DMD, PC

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

General Provider Information

NPI Number	:	1811309057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSOURI DENTAL PROFESSIONALS, RICHARD STRAUS, DMD, PC

Provider Business Mailing Address
First Line	:	9420 WATSON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-1529
Country	:	US
Telephone Number	:	314-843-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	9420 WATSON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-1529
Country	:	US
Telephone Number	:	314-843-0500
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING TEAM LEAD
Name	:	KENDRA WALKER
Credential	:
Telephone Number	:	217-540-8513

Provider Enumeration Date	:	05/22/2014
Last Update Date	:	04/25/2018

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