MEDICARE: ST. PETERS ORTHODONTICS 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1902430515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. PETERS ORTHODONTICS LLC

Provider Business Mailing Address
First Line	:	5913 MEXICO RD
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-1613
Country	:	US
Telephone Number	:	636-939-3777
Fax Number	:

Provider Business Practice Location Address
First Line	:	5913 MEXICO RD
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-1613
Country	:	US
Telephone Number	:	636-939-3777
Fax Number	:

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	BECKY SCHREINER
Credential	:	DDS
Telephone Number	:	636-939-3777

Provider Enumeration Date	:	02/24/2020
Last Update Date	:	02/24/2020

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