Gateway Oral and Maxillofacial Surgeons of St Louis, P.C.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

12435 Issued in MO

Legal business name

GATEWAY ORAL AND MAXILLOFACIAL SURGEONS OF ST LOUIS, P.C.

Practice address

165 N. Meramec Ave
Suite 300
Clayton, MO 63105-3772

Phone

(314) 726-2755

Fax

(314) 726-9538

NPI assigned

Feb 13, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Daun M. Brandt

Title

Business Manager

Phone

(314) 726-2755

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Travis & Nolen Oral & Maxillofacial Surgery, P.C. Former legal business name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Hiran R Fernando, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Clayton, MO
  • NPI 1164634135
  NPD
• Scott F Nolen, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Clayton, MO
  • NPI 1659443919
  NPD

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

{
    "created_epoch": "1202860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681171200000",
    "number": "1184892028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 N. MERAMEC AVE",
            "address_2": "SUITE 300",
            "city": "CLAYTON",
            "state": "MO",
            "postal_code": "631053772",
            "telephone_number": "314-726-2755",
            "fax_number": "314-726-9538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 N. MERAMEC AVE",
            "address_2": "SUITE 300",
            "city": "CLAYTON",
            "state": "MO",
            "postal_code": "631053772",
            "telephone_number": "314-726-2755",
            "fax_number": "314-726-9538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GATEWAY ORAL AND MAXILLOFACIAL SURGEONS OF ST LOUIS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-13",
        "last_updated": "2023-04-11",
        "certification_date": "2023-04-11",
        "status": "A",
        "authorized_official_last_name": "BRANDT",
        "authorized_official_first_name": "DAUN",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "314-726-2755",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MO",
            "license": "12435",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP ID",
            "identifier": "990001492",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Travis & Nolen Oral & Maxillofacial Surgery, P.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Matthew Alan Flory, DC
• Haley Focht
• For Love & Money, Inc
• Lauren Michele Freels, PHARMD
• Ariela Freeman, LCSW
• Courtney Deanna Gehrer, LCSW
• Marisa Gelfand, M.ED, LPC, NCC
• Justin Daniel Gellman, BS
• Leigh H Gerard, MA,PLPC
• Gina Gershilevich, MA, PLPC

• Oral and Maxillofacial Surgery (Dentist) in Clayton, MO
• Providers in Clayton, MO by specialty
• Oral and Maxillofacial Surgery (Dentist) in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.