MEDICARE: DR. SHELLY LYNN SARICH D.D.S., M.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	1223E0200X	Endodontics	2000154623	MO

General Provider Information

NPI Number	:	1841218807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELLY LYNN SARICH D.D.S., M.S.

Provider Business Mailing Address
First Line	:	1053 RONDALE COURT
Second Line	:
City	:	DARDENNE PRAIRIE
State	:	MO
Zip	:	63368
Country	:	US
Telephone Number	:	636-379-4500
Fax Number	:	636-272-4551

Provider Business Practice Location Address
First Line	:	1053 RONDALE COURT
Second Line	:
City	:	DARDENNE PRAIRIE
State	:	MO
Zip	:	63368
Country	:	US
Telephone Number	:	636-379-4500
Fax Number	:	636-272-4551

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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