NPIMap

Organization Active NPI

PLD of South City PC

Doing business as Pine Lawn Dental

  • General Practice Dentistry
  • Saint Louis, MO
National Provider Identifier
1871479758
Registry record updated May 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PLD OF SOUTH CITY PC
Doing business as
Pine Lawn Dental
Practice address
3859 Gravois Ave
Saint Louis, MO 63116-4657
Phone
(314) 382-2000
Fax
(314) 382-2411
NPI assigned
Aug 14, 2025
Last updated
May 7, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2026

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

Authorized official

Name
Dr. Michael Travis, DDSNPI 1649566654
Title
Owner
Phone
(314) 635-0822

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X NU Primary

Addresses

Primary practice location

3859 Gravois Ave
Saint Louis, MO 63116-4657

Mailing address

3708 Jennings Station Rd
Saint Louis, MO 63121-3500
Phone (314) 382-2000

Other names 1

  • Pine Lawn Dental Doing business as

National Provider Directory

National Provider Directory

Locations

3708 Jennings Station Rd
Saint Louis, MO 63121
Phone (314) 380-9600

3859 Gravois Ave
Saint Louis, MO 63116
Phone (314) 382-2000

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1755129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778112000000",
    "number": "1871479758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3708 JENNINGS STATION RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631213500",
            "telephone_number": "314-382-2000",
            "fax_number": "314-382-2411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3859 GRAVOIS AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631164657",
            "telephone_number": "314-382-2000",
            "fax_number": "314-382-2411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLD OF SOUTH CITY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-14",
        "last_updated": "2026-05-07",
        "certification_date": "2026-05-07",
        "status": "A",
        "authorized_official_last_name": "TRAVIS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-635-0822",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Lawn Dental",
            "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 7, 2026; 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.