Active NPI
Gerald Russell Ledoux, DDS
- Dentist
- Saint Charles, MO
National Provider Identifier
1083725451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 10572
- Practice address
- 2665 West Clay
St Charles, MO 63301 - Phone
- (636) 916-4448
- Fax
- (636) 946-5188
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 10572 | MO | Primary |
Addresses
Primary practice location
2665 West Clay
St Charles, MO 63301
Mailing address
2665 West Clay
St Charles, MO 63301
Phone (636) 916-4448
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10572 | MO | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083725451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2665 WEST CLAY",
"city": "ST CHARLES",
"state": "MO",
"postal_code": "63301",
"telephone_number": "636-916-4448",
"fax_number": "636-946-5188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2665 WEST CLAY",
"city": "ST CHARLES",
"state": "MO",
"postal_code": "63301",
"telephone_number": "636-916-4448",
"fax_number": "636-946-5188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEDOUX",
"first_name": "GERALD",
"middle_name": "RUSSELL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MO",
"license": "10572",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Charles, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.