| Mo Specialty Dental Services, LLC | |
|
4142 Keaton Crossing Blvd Ste 10 O Fallon MO 63368-8404 | |
| (636) 244-2620 | |
| Not Available |
| Full Name | Mo Specialty Dental Services, LLC |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 4142 Keaton Crossing Blvd Ste 10, O Fallon, Missouri |
| Authorized Official Name and Position | Charlotte Dasch (DIRECTOR OF PROVIDER RELATIONS) |
| Authorized Official Contact | 5046380303 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mo Specialty Dental Services, LLC 1610 54th Ave N Ste 205 Nashville TN 37209-1442 Ph: (615) 678-0759 | Mo Specialty Dental Services, LLC 4142 Keaton Crossing Blvd Ste 10 O Fallon MO 63368-8404 Ph: (636) 244-2620 |
| NPI Number | 1811624141 |
|---|---|
| Provider Enumeration Date | 08/05/2022 |
| Last Update Date | 08/05/2022 |
| Certification Date | 08/05/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811624141 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | () | Primary |
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