Active NPI
Peter Gontarz, DMD
- Dentist
- Saint Ann, MO
National Provider Identifier
1295265320
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2017017918
- Practice address
- 500 NW Plaza Dr Ste 524
Saint Ann, MO 63074-2220 - Phone
- (573) 751-0042
- NPI assigned
- Jun 12, 2017
- Last updated
- Jun 12, 2017
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 2017017918 | MO | Primary |
Addresses
Primary practice location
500 NW Plaza Dr Ste 524
Saint Ann, MO 63074-2220
Mailing address
525 Lexington Landing Dr
Saint Charles, MO 63303-1749
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 |
|---|---|---|---|
| 2017017918 | MO | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1497225600000",
"number": "1295265320",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "525 LEXINGTON LANDING DR",
"city": "SAINT CHARLES",
"state": "MO",
"postal_code": "633031749"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 NW PLAZA DR STE 524",
"city": "SAINT ANN",
"state": "MO",
"postal_code": "630742220",
"telephone_number": "573-751-0042"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONTARZ",
"first_name": "PETER",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-06-12",
"last_updated": "2017-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MO",
"license": "2017017918",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Ann, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.