Michael and Angela Pernoud, DDS, PC

Primary specialty

DentistTaxonomy code 122300000X

License

2006021264 Issued in MO

Legal business name

MICHAEL AND ANGELA PERNOUD, DDS, PC

Doing business as

Hawk Ridge Dental Care

Practice address

8631 Highway N
Lake St. Louis, MO 63367

Phone

(636) 561-4540

Fax

(636) 561-4601

NPI assigned

Dec 14, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Angela K Pernoud, DDS

Title

Secretary

Phone

(636) 561-4540

Specialties & licenses 1

Addresses

Other names 1

• Hawk Ridge Dental Care Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1197590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197590400000",
    "number": "1013190875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8631 HIGHWAY N",
            "city": "LAKE ST. LOUIS",
            "state": "MO",
            "postal_code": "63367",
            "telephone_number": "636-561-4540",
            "fax_number": "636-561-4601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8631 HIGHWAY N",
            "city": "LAKE ST. LOUIS",
            "state": "MO",
            "postal_code": "63367",
            "telephone_number": "636-561-4540",
            "fax_number": "636-561-4601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL AND ANGELA PERNOUD, DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-14",
        "last_updated": "2007-12-14",
        "status": "A",
        "authorized_official_last_name": "PERNOUD",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "636-561-4540",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MO",
            "license": "2006021264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hawk Ridge Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in Lake St. Louis, MO
• Providers in Lake St. Louis, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.