Mo Specialty Dental Services, LLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

MO SPECIALTY DENTAL SERVICES, LLC

Practice address

4142 Keaton Crossing Blvd Ste 10
O Fallon, MO 63368-8404

Phone

(636) 244-2620

NPI assigned

Aug 5, 2022

Organization subpart

No

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

Authorized official

Name

Charlotte Dasch

Title

Director of Provider Relations

Phone

(504) 638-0303

Specialties & licenses 1

Addresses

Tax ID family

Mo Specialty Dental Services LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mo Specialty Dental Services, LLC

  dba St. Louis Pediatric Dentistry

  • Pediatric Dentistry
  • Saint Louis, MO
  • NPI 1386484137
  NPD tax ID

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Mo Specialty Dental Services, LLC

  dba St. Louis Pediatric Dentistry

  • Pediatric Dentistry
  • Saint Louis, MO
  • NPI 1386484137
  NPPES parent name

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

{
    "created_epoch": "1659657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659657600000",
    "number": "1811624141",
    "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": "4142 KEATON CROSSING BLVD STE 10",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633688404",
            "telephone_number": "636-244-2620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MO SPECIALTY DENTAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-05",
        "last_updated": "2022-08-05",
        "certification_date": "2022-08-05",
        "status": "A",
        "authorized_official_last_name": "DASCH",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_title_or_position": "DIRECTOR OF PROVIDER RELATIONS",
        "authorized_official_telephone_number": "504-638-0303"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Missouri Dental Professionals, Richard Straus, DMD, PC (Deer Creek Dental)
• Missouri Injury Clinics West, LLC
• Betty Mitchell, NP
• Nikkeia Denise Mitchell, DPT
• Erin Mittler
• Mark Moan, DMD
• Marie Moder
• Hanna Moellenhoff, LCSW
• Stacey L Mohn, R.PH
• Aaron Eugene Mohr, DC

• Pediatric Dentistry in O'Fallon, MO
• Providers in O'Fallon, MO by specialty
• Pediatric Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2022; 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.