Active NPI
Thomas Lease, DDS, MSD
- Periodontics
- Saint Louis, MO
National Provider Identifier
1104905892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 011766
- Practice address
- 443 N New Ballas Rd
Ste. 215
Saint Louis, MO 63141-6800 - Phone
- (314) 567-4430
- Fax
- (314) 567-3014
- NPI assigned
- Nov 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 011766 | MO | Primary |
Addresses
Primary practice location
443 N New Ballas Rd
Ste. 215
Saint Louis, MO 63141-6800
Mailing address
443 N New Ballas Rd
Ste. 215
Saint Louis, MO 63141-6800
Phone (314) 567-4430
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 |
|---|---|---|---|
| 011766 | MO | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104905892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "443 N NEW BALLAS RD",
"address_2": "STE. 215",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631416800",
"telephone_number": "314-567-4430",
"fax_number": "314-567-3014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "443 N NEW BALLAS RD",
"address_2": "STE. 215",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631416800",
"telephone_number": "314-567-4430",
"fax_number": "314-567-3014"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEASE",
"first_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "DDS, MSD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MO",
"license": "011766",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, 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.