Individual provider Active NPI

Dennis Senderovich, D.D.S.

  • General Practice Dentistry
  • O Fallon, MO
National Provider Identifier
1811045446
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2002011686 Issued in MO
Practice address
9979 Winghaven Blvd
202
O Fallon, MO 63368-3627
Phone
(636) 561-7072
NPI assigned
Jan 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2002011686 MO Primary

Addresses

Primary practice location

9979 Winghaven Blvd
202
O Fallon, MO 63368-3627

Mailing address

9979 Winghaven Blvd Ste 202
O Fallon, MO 63368-3628
Phone (636) 561-7072

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

LicenseStateTypeSpecialty
2002011686MOMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811045446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9979 WINGHAVEN BLVD STE 202",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633683628",
            "telephone_number": "636-561-7072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9979 WINGHAVEN BLVD",
            "address_2": "202",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633683627",
            "telephone_number": "636-561-7072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SENDEROVICH",
        "first_name": "DENNIS",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2002011686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O Fallon, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.