Keith Fletcher Anderson, D.M.D.
Individual provider Active NPI Dentist · Saint Louis, MO
NPI 1356401459 · NPPES record last updated Jul 18, 2011
Key facts
- NPI
- 1356401459
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 014386 (MO)
- Practice address
- 9225 Manchester Rd
Suite 202
Saint Louis, MO 63144-2640 - Phone
- (314) 961-5866
- Fax
- (314) 918-0165
- NPI assigned
- Dec 11, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160203002690 | MO | Order and Referring Only - Dentist |
5698079127 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Claudia Gray Smiles, LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 014386 | MO | Yes |
Addresses
Primary practice location
9225 Manchester Rd
Suite 202
Saint Louis, MO 63144-2640
Mailing address
9225 Manchester Rd
Suite 202
Saint Louis, MO 63144-2640
Phone (314) 961-5866
Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.