Gavin Shibli Tarazi, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2025036865 Issued in MO

Practice address

11941 Manchester Rd
Des Peres, MO 63131-4502

Phone

(314) 501-8300

NPI assigned

Aug 27, 2025

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1756252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756252800000",
    "number": "1740169630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 E 3RD ST APT A",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620022407",
            "telephone_number": "815-382-7291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11941 MANCHESTER RD",
            "city": "DES PERES",
            "state": "MO",
            "postal_code": "631314502",
            "telephone_number": "314-501-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TARAZI",
        "first_name": "GAVIN",
        "middle_name": "SHIBLI",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-08-27",
        "last_updated": "2025-08-27",
        "certification_date": "2025-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2025036865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Stiles
• Sarah A Stolker, P.T.
• Susan Griffin Sullivan, MA, LPC
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• Caroline Tringale

• General Practice Dentistry in Des Peres, MO
• Providers in Des Peres, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 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.