MIDWEST MOBILE DENTISTRY LLC (NPI# 1417477985) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417477985 |
| Entity Type | Organization |
| Organization Name | MIDWEST MOBILE DENTISTRY LLC |
| Practice Address |
1 N Brentwood Blvd Ste 1000 Saint Louis MO 63105-3937 |
| Mailing Address |
1 North Brentwood Boulevard Suite 1000 St Louis MO 63105 |
| Practice Telephone | (225) 287-8765 |
| Practice Fax Number | 6152258915 |
| Mailing Telephone | 2252878765 |
| Mailing Fax Number | 6152258915 |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2017-06-26 |
| Authorized Official Name | JEREMY GORDON GRAHAM (OWNER/CEO) |
| Authorized Official Telephone | 2252878765 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
MO | Ambulatory Health Care Facilities |
| Street Address |
1 N BRENTWOOD BLVD STE 1000 |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63105-3937 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861016545 | Amy Piontek | Registered Nurse | Habif Health and Wellness Center, 6643 Shepley Drive, St. Louis, MO 63105 | 2020-05-29 |
| 1427520634 | Justin Kelly | Chiropractor | 8011 Maryland Avenue, St. Louis, MO 63105 | 2018-12-28 |
| 1720576663 | St. Louis Center for Cognitive Health, LLC | Clinic/Center | 7711 Bonhomme Ave Ste 350, Clayton, MO 63105 | 2018-04-26 |
| 1457849317 | A Storied Life Counseling LLC | Social Worker | 8000 Bonhomme Ave Ste 321, Clayton, MO 63105 | 2018-04-26 |
| 1669984142 | Peter Bogart | Counselor | 7710 Carondelet, Suite #204, Saint Louis, MO 63105 | 2017-10-24 |
| 1356891162 | Medical West Respiratory Pharmacy, LLC | Pharmacy | 440 South Brentwood Blvd, Clayton, MO 63105 | 2016-10-05 |
| 1710435565 | James Breihan | Occupational Therapist | 401 Corporate Park Drive, Clayton, MO 63105 | 2016-09-21 |
| 1730566928 | Frank Theus | Counselor | 7710 Carondelet Ave Ste 220, Saint Louis, MO 63105 | 2015-04-27 |
| 1962895896 | John B Martin | Obstetrics & Gynecology | 312 N. Meramec #300, St. Louis, MO 63105 | 2015-03-17 |
| 1861814261 | Jesse Marie Civello | Physical Therapist | 222 S Meramec Avenue, Suite 100, Clayton, MO 63105 | 2014-01-20 |
| Find all providers in zip 63105 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144835828 | Rem Dds, LLC | Clinic/Center | 10000 Watson Rd Ste 2mm, Saint Louis, MO 63126-1848 | 2020-09-10 |
| 1003434234 | Jason L Allen Dmd LLC | Clinic/Center | 5147 Daggett Ave, Saint Louis, MO 63110-3009 | 2020-07-14 |
| 1538630629 | A Hallie Lillmars Dds LLC | Clinic/Center | 8720 Big Bend Blvd Ste A, Saint Louis, MO 63119-3730 | 2018-12-16 |
| 1396215273 | Aaron J Cregger Dds LLC | Clinic/Center | 2821 N Ballas Rd Ste 260, Saint Louis, MO 63131-2378 | 2018-12-04 |
| 1144686320 | Raymond J Skosky, Dds,llc | Clinic/Center | 5530 Virginia Ave, Saint Louis, MO 63111-1939 | 2016-01-04 |
| 1437456001 | Plaza Health Dentistry | Clinic/Center | 9420 Watson Rd, Saint Louis, MO 63126-1529 | 2011-02-17 |
| 1053467746 | St. Louis University | Clinic/Center | 3320 Rutger St, Saint Louis, MO 63104-1122 | 2007-01-26 |
| 1780797308 | Jack M. Marincel, D.d.s., P.C. | Clinic/Center | 6060 Telegraph Rd, Suite H, Saint Louis, MO 63129-4762 | 2006-08-16 |
| 1033617386 | Carestl Health | Clinic/Center | 4500 Pope Ave, Saint Louis, MO 63115 | 2018-01-31 |
| 1245742204 | Tom Sotiropoulos Metro Dental Sleep Medicine | Clinic/Center | 11222 Tesson Ferry Rd Ste 203, Saint Louis, MO 63123-6963 | 2017-10-31 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63105 |
Please comment or provide details below to improve the information on MIDWEST MOBILE DENTISTRY LLC.
| 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.