GREGORY PERNOUD (NPI# 1265868863) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265868863 |
| Entity Type | Individual |
| Full Name | GREGORY PERNOUD |
| Credential | DDS |
| Practice Address |
1204 E State Route 72 Rolla MO 65401-3938 |
| Mailing Address |
112 S 2nd St Festus MO 63028-2201 |
| Practice Telephone | 5733641934 |
| Practice Fax Number | 5733648110 |
| Mailing Telephone | 6369371515 |
| Mailing Fax Number | 6369370790 |
| Enumeration Date | 2013-09-16 |
| Last Update Date | 2013-09-16 |
| 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 |
012735 | MO | Dental Providers |
| Street Address |
1204 E STATE ROUTE 72 |
| City | ROLLA |
| State | MO |
| Zip Code | 65401-3938 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639645591 | Samantha Jo Mitchell | Pharmacist | 1375 E 10th St Suite B, Rolla, MO 65401 | 2018-10-18 |
| 1427567726 | Gerry Wade Funkhouser Jr. | Counselor | 103 W 10th St, Rolla, MO 65401 | 2017-09-29 |
| 1366967960 | Shana Hintz Wisniewski | Social Worker | 1000 W. 10th St., Rolla, MO 65401 | 2017-08-04 |
| 1174066559 | Tabitha Hundt | Counselor | 1011 Cypress Dr, Rolla, MO 65401 | 2016-12-02 |
| 1841742855 | Alpha Assisted Living LLC | Assisted Living Facility | 13450 Cr 7040, 803 E 12th St, Rolla, MO 65401 | 2016-10-26 |
| 1275916884 | Elizabeth Zersen | Occupational Therapist | 2053 Vienna Rd, Rolla, MO 65401 | 2015-06-30 |
| 1386047025 | Becky L Witham | Nurse Practitioner | 1060 W 10th Street, Rolla, MO 65401 | 2014-10-08 |
| 1114326121 | Summer Adey | Licensed Practical Nurse | 13750 State Route F, Rolla, MO 65401 | 2014-08-14 |
| 1518303296 | Leaetta Mildred Gardner | Nursing Facility/Intermediate Care Facility | 13450 County Road 7040, Rolla, MO 65401 | 2013-05-21 |
| 1316282064 | Susan Peitz Gruener | Occupational Therapy Assistant | 1800 White Column Road, Rolla, MO 65401 | 2012-12-06 |
| Find all providers in zip 65401 | ||||
| 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 |
|---|---|---|---|---|
| 1881202943 | Kansas City Oral Surgery & Implant Center | Dentist | 8771 N Platte Purchase Dr, Kansas City, MO 64155-1829 | 2020-07-15 |
| 1700403722 | Kansas City Facial and Oral Surgery, LLC | Dentist | 2931 Ne Independence Ave., Lees Summit, MO 64064-6406 | 2020-06-26 |
| 1134767866 | Courtney Ethington | Dentist | 4 West Dr Ste 170, Chesterfield, MO 63017-1793 | 2019-12-12 |
| 1184130528 | Archway Oral Surgery and Dental Implants | Dentist | 16 Hampton Village Plz Ste 200, Saint Louis, MO 63109-2128 | 2017-12-21 |
| 1780120410 | Ervin Simmons Iv Dmd LLC | Dentist | 3220 Parker Rd, Florissant, MO 63033-3733 | 2017-01-19 |
| 1437531209 | Federico Castillo Iv | Dentist | 2521 Cherry St, Kansas City, MO 64108-2750 | 2015-06-29 |
| 1437579208 | Gregory Lohr | Dentist | 2931 Ne Independence Ave, Lees Summit, MO 64064 | 2014-04-21 |
| 1114347861 | Zachary L Brown | Dentist | 4700 Belleview Ave Ste L10, Kansas City, MO 64112-1360 | 2014-04-21 |
| 1942551247 | Kansas City Surgical Arts LLC | Dentist | 8080 North Flintlock Road, Kansas City, MO 64158 | 2012-09-26 |
| 1114217585 | Southeast Missouri Oral & Maxillofacial Surgery | Dentist | 1325 N Mount Auburn Rd, Cape Girardeau, MO 63701-1722 | 2011-04-19 |
| Find all providers with the same taxonomy | ||||
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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.