NPIMap

Organization Active NPI

16111 Manchester Road, L.L.C.

Doing business as Zieba Family Dentistry

  • General Practice Dentistry
  • Ellisville, MO
National Provider Identifier
1013386598
Registry record updated Sep 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2000169958 Issued in MO
Legal business name
16111 MANCHESTER ROAD, L.L.C.
Doing business as
Zieba Family Dentistry
Practice address
428 Old State Rd.
Ellisville, MO 63021
Phone
(636) 391-6030
Fax
(636) 527-8386
NPI assigned
Sep 15, 2015
Last updated
Sep 15, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2015

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

Authorized official

Name
Mr. Charles M. Zieba, DMDNPI 1720092489
Title
Dentist/Owner
Phone
(636) 391-6030

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 2000169958 MO Primary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 2000165488 MO

Addresses

Primary practice location

428 Old State Rd.
Ellisville, MO 63021

Mailing address

428 Old State Rd.
Ellisville, MO 63021
Phone (636) 391-6030

Other names 1

  • Zieba Family Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

428 Old State Rd
Ellisville, MO 63021
Phone (636) 394-5446

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1442275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442275200000",
    "number": "1013386598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "428 OLD STATE RD.",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "63021",
            "telephone_number": "636-391-6030",
            "fax_number": "636-527-8386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "428 OLD STATE RD.",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "63021",
            "telephone_number": "636-391-6030",
            "fax_number": "636-527-8386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "16111 MANCHESTER ROAD, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-15",
        "last_updated": "2015-09-15",
        "status": "A",
        "authorized_official_last_name": "ZIEBA",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "636-391-6030",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2000169958",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2000165488",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Zieba Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ellisville, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2015; 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.