Abby Detweiler

Primary specialty

DentistTaxonomy code 122300000X

License

2019038682 Issued in MO

Practice address

4055 Lindell Blvd
Saint Louis, MO 63108-3201

Phone

(314) 535-7701

NPI assigned

Oct 7, 2019

Last updated

Mar 28, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Missouri Dental Professionals, Richard Straus, DMD, PC

  dba Heritage Dental Group

  • General Practice Dentistry
  • Saint Peters, MO
  • NPI 1740400282
  NPD (past)

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

{
    "created_epoch": "1570406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648425600000",
    "number": "1881235323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5701 DELMAR BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631122617",
            "telephone_number": "314-367-7848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4055 LINDELL BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631083201",
            "telephone_number": "314-535-7701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETWEILER",
        "first_name": "ABBY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-07",
        "last_updated": "2022-03-28",
        "certification_date": "2022-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2019038682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "400092156",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.nextmd.com",
            "affiliation": "N",
            "endpointDescription": "HIE",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "4055 Lindell Blvd",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631083201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.nextmd.com",
            "affiliation": "N",
            "address_1": "4055 Lindell Blvd",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631083201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nickolai C Detert, DNP, FNP-C
• Tyler T Detmer, DPT
• Patricia Ann Dettenmeier, MSN CS
• Rachel E Dettleff-Schmidt, LCSW
• Matthew Robert Dettmer, MD
• Ashley Detweiler, PT
• Jamie Deubel, DNP, CRNA
• Robert H Deusinger, PT PHD
• Susan Deusinger, PT PHD
• Angela Louise Deutsch, COTA

• Dentist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 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.