William Gordon Dewert, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

012134 Issued in MO

Practice address

12758 Boenker LN
Bridgeton, MO 63044-2436

Phone

(314) 739-3300

Fax

(314) 739-0005

NPI assigned

Feb 21, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083759518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 JUMPER HILL CT",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630173448",
            "telephone_number": "314-434-8504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12758 BOENKER LN",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442436",
            "telephone_number": "314-739-3300",
            "fax_number": "314-739-0005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEWERT",
        "first_name": "WILLIAM",
        "middle_name": "GORDON",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "012134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dermatology Specialists Inc
• Juhi Hetal Desai
• Christina Desalvo
• Venkata R Devineni, MD
• Devotional Home Services of STL LLC
• Amrjit Kaur Dhillon, MSN, APRN, AGNP-C
• Marcie Dick, MSW
• Paul J Diesfeld, PA-C
• Michael Brian Dietrich, D.M.D.
• Mary Frances Digregorio, MSW, APRN, BC, NP-C,

• General Practice Dentistry in Bridgeton, MO
• Providers in Bridgeton, MO by specialty
• General Practice Dentistry in Missouri

• 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.

Verify at the official NPI Registry.