Active NPI
Mo Specialty Dental Services, LLC
Doing business as St. Louis Pediatric Dentistry
- Pediatric Dentistry
- Saint Louis, MO
National Provider Identifier
1386484137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- Legal business name
- MO SPECIALTY DENTAL SERVICES, LLC
- Doing business as
- St. Louis Pediatric Dentistry
- Practice address
- 2325 Dougherty Ferry Rd Ste 200
Saint Louis, MO 63122-3356 - Phone
- (314) 394-1914
- NPI assigned
- May 29, 2024
- Last updated
- May 29, 2024
- Organization subpart
- Yes
- Parent organization
- MO SPECIALTY DENTAL SERVICES, LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Charlotte Dasch
- Title
- Direc of Cred and PR
- Phone
- (504) 638-0303
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | NU | Primary |
Addresses
Primary practice location
2325 Dougherty Ferry Rd Ste 200
Saint Louis, MO 63122-3356
Mailing address
1610 54TH Ave N Ste 205
Nashville, TN 37209-1442
Phone (615) 678-0759
Other names 1
- St. Louis Pediatric Dentistry
National Provider Directory
National Provider Directory- Tax ID family
- Mo Specialty Dental Services LLC
- Part of
- Mo Specialty Dental Services LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Pediatric Dentistry
- O'Fallon, MO
- NPI 1811624141
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Pediatric Dentistry
- O'Fallon, MO
- NPI 1811624141
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716940800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1716940800000",
"number": "1386484137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1610 54TH AVE N STE 205",
"city": "NASHVILLE",
"state": "TN",
"postal_code": "372091442",
"telephone_number": "615-678-0759"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2325 DOUGHERTY FERRY RD STE 200",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631223356",
"telephone_number": "314-394-1914"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MO SPECIALTY DENTAL SERVICES, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MO SPECIALTY DENTAL SERVICES, LLC",
"enumeration_date": "2024-05-29",
"last_updated": "2024-05-29",
"certification_date": "2024-05-29",
"status": "A",
"authorized_official_last_name": "DASCH",
"authorized_official_first_name": "CHARLOTTE",
"authorized_official_title_or_position": "DIREC OF CRED AND PR",
"authorized_official_telephone_number": "504-638-0303"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "St. Louis Pediatric Dentistry",
"code": "3",
"type": "Doing Business As"
}
]
}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 May 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.