NPIMap

Organization Active NPI

Provide Dental

  • Dental Clinic/Center
  • Chesterfield, MO
National Provider Identifier
1124990601
Registry record updated Sep 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
PROVIDE DENTAL
Practice address
13371 Olive Blvd # 3108
Chesterfield, MO 63017-3108
Phone
(314) 878-5544
NPI assigned
Sep 23, 2025
Organization subpart
Yes
Parent organization
PROVIDE DENTALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 23, 2025

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

Authorized official

Name
Philip Son, DMD
Title
Dentist
Phone
(323) 787-9397

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

13371 Olive Blvd # 3108
Chesterfield, MO 63017-3108

Mailing address

13371 Olive Blvd # 3108
Chesterfield, MO 63017-3108
Phone (314) 878-5544

Other names 1

  • Provide Dental- Chesterfield Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Provide Dental3 organizations share this tax ID, including this one
Part of
Provide Dental

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

13371 Olive Blvd
#3108
Chesterfield, MO 63017
Phone (314) 878-5544

NPI Registry JSON

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

{
    "created_epoch": "1758585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758585600000",
    "number": "1124990601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13371 OLIVE BLVD # 3108",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630173108",
            "telephone_number": "314-878-5544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13371 OLIVE BLVD # 3108",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630173108",
            "telephone_number": "314-878-5544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDE DENTAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDE DENTAL",
        "enumeration_date": "2025-09-23",
        "last_updated": "2025-09-23",
        "certification_date": "2025-09-23",
        "status": "A",
        "authorized_official_last_name": "SON",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "323-787-9397",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Provide Dental- Chesterfield",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chesterfield, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2025; 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.