Natalia C Habibi, DMD
Individual provider Active NPI General Practice Dentistry · Weldon Spring, MO
NPI 1063965614 · NPPES record last updated Jun 21, 2024
Key facts
- NPI
- 1063965614
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 019030912 (IL)
- Practice address
- 810 Ofallon Rd Ste 80
Weldon Spring, MO 63304-8107 - Phone
- (636) 244-4052
- NPI assigned
- Aug 1, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160812000002 | IL | Order and Referring Only - Dentist |
5597059667 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN1859245 | MA | MD | Dentist |
| 2017012882 | MO | MD | Dentist |
| 019030912 | IL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Soh of Missouri Samson Liu PC | Dentist | Current |
Accepting new patients |
Locations
111 N Highway 67 St
Florissant, MO 63031
Phone (314) 408-8390
810 Ofallon Rd
Ste 80
Weldon Spring, MO 63304
Phone (636) 244-4052
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2017012882 | MO | |
| Dentist | 122300000X | DN1859245 | MA | |
| General Practice Dentistry | 1223G0001X | 019030912 | IL | Yes |
Addresses
Primary practice location
810 Ofallon Rd Ste 80
Weldon Spring, MO 63304-8107
Mailing address
810 Ofallon Rd Ste 80
Weldon Spring, MO 63304-8107
Phone (636) 244-4052
Other practice location 1
2800 College Ave
Alton, IL 62002-4700
Phone (618) 474-7000
Other practice location 2
111 N Highway 67 St
Florissant, MO 63031-5901
Phone (314) 408-8390
Other providers in Weldon Spring, MO
- Kristen Marie Frish
- Jordan Gericke
- Clarice Karine Gerke
- Rima Gandhi Ghosh
- Shannon Meredith Gruzeski
- Sarah Kealey Haeusser
- Cynthia May Halbrook
- Holly Hamilton
- Todd Hamilton
- Andrea Hamrick
All providers in Weldon Spring, MO · General Practice Dentistry in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 21, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.