DR. DOMINIC MOREL-MAYNARD (NPI# 1073800520) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073800520 |
| Entity Type | Individual |
| Full Name | DR. DOMINIC MOREL-MAYNARD |
| Credential | D.M.D. |
| Practice Address |
621 S New Ballas Rd Ste 16a Saint Louis MO 63141-8239 |
| Practice Telephone | 3142516725 |
| Practice Fax Number | 3142516726 |
| Mailing Telephone | 3142516725 |
| Mailing Fax Number | 3142516726 |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2019-01-18 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
2018010876 | MO | Dental Providers |
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
DN 21761 | FL | Dental Providers |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 111 E 210th St, Bronx, NY 104672401 | 7189205993 | |
| 7401 N University Dr Ste 102, Tamarac, FL 333212933 | 9547217990 |
| Street Address |
621 S NEW BALLAS RD STE 16A |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63141-8239 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346382678 | Ramani Gowducheruvu | Dentist | 621 S New Ballas Rd Ste 16a, Saint Louis, MO 63141-8239 | 2007-02-13 |
| 1770962953 | Kiara Danielle Brown | Dentist | 621 S New Ballas Rd Ste 16a, Saint Louis, MO 63141-8239 | 2015-05-21 |
| 1396180436 | Dustin R Altmann | Dentist | 621 S New Ballas Rd Ste 16a, Saint Louis, MO 63141-8239 | 2013-05-02 |
| 1164866125 | Gregory Stephen Tentindo | Dentist | 621 S New Ballas Rd Ste 16a, Saint Louis, MO 63141-8239 | 2013-04-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679102842 | Noor Ramadan | Pharmacist | 628 North New Ballad Road, Suite A, Creve Coeur, MO 63141 | 2020-04-08 |
| 1497381206 | Washington University | Durable Medical Equipment & Medical Supplies | 1044 North Mason Road, Suite 110/210, St. Louis, MO 63141 | 2020-03-13 |
| 1154956498 | Ashleigh Clendenny | Physician Assistant | Mercy Hospital St. Louis, 615 S New Ballas Rd, St. Louis, MO 63141 | 2020-03-06 |
| 1801429410 | Emili Lou Haley | Registered Nurse | 650 Maryville Drive, St Louis, MO 63141 | 2020-02-21 |
| 1629553110 | Rebecca Kathleen Pike | Social Worker | West County Psychological Associates, 12125 Woodcrest Executive Drive #110, St. Louis, MO 63141 | 2018-10-01 |
| 1649756099 | River City Sedation Associates, LLC | Nurse Anesthetist, Certified Registered | 12855 N 40 Dr Ste 150, Saint Louis, MO 63141 | 2018-07-18 |
| 1205333952 | Ear Care and Hearing of St. Louis | Hearing Aid Equipment | 11630 Studt Ave Ste 210, Creve Coeur, MO 63141 | 2018-04-10 |
| 1659897486 | Erin Goodman | Physical Therapist | 10560 Old Olive St. Rd, Suite 100, Creve Coeur, MO 63141 | 2017-08-14 |
| 1093230450 | Center for Urologic Surgery LLC | Clinic/Center | 12855 N 40 Dr Ste 100, Saint Louis, MO 63141 | 2017-08-07 |
| 1871016105 | Jacob Farley Tanner | Specialist/Technologist | 1054 Town and Four Parkway Dr, Creve Coeur, MO 63141 | 2017-07-19 |
| Find all providers in zip 63141 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184130528 | Archway Oral Surgery and Dental Implants | Dentist | 16 Hampton Village Plz Ste 200, Saint Louis, MO 63109-2128 | 2017-12-21 |
| 1346382678 | Ramani Gowducheruvu | Dentist | 621 S New Ballas Rd Ste 16a, Saint Louis, MO 63141-8239 | 2007-02-13 |
| 1528503026 | Stewart E Moreland, Dmd, LLC | Dentist | 2821 N Ballas Rd, Suite 225, Saint Louis, MO 63131-2321 | 2016-12-20 |
| 1891107132 | Creve Coeur Oral Surgery | Dentist | 605 Old Ballas Rd, Suite 130, Saint Louis, MO 63141-7000 | 2014-05-21 |
| 1396180436 | Dustin R Altmann | Dentist | 621 S New Ballas Rd Ste 16a, Saint Louis, MO 63141-8239 | 2013-05-02 |
| 1164866125 | Gregory Stephen Tentindo | Dentist | 621 S New Ballas Rd Ste 16a, Saint Louis, MO 63141-8239 | 2013-04-22 |
| 1568788925 | Collin Miles Stutz | Dentist | 605 Old Ballas Rd, Saint Louis, MO 63141-7000 | 2010-04-10 |
| 1821228628 | Robert Alexander Peter Reti | Dentist | 10000 Watson Rd, A, Saint Louis, MO 63126-1841 | 2009-07-15 |
| 1982870663 | Marc Gayed | Dentist | 4121 Elm Park Dr, Saint Louis, MO 63128 | 2008-05-02 |
| 1114190220 | Allen Sclaroff Dds Inc | Dentist | 1 Barnes Jewish Hospital Plz, Suite 16432, Saint Louis, MO 63110-1003 | 2008-04-09 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63141 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.