NPIMap

Organization Active NPI

Missouri Dental Professionals, Richard Straus, DMD, PC

Doing business as Creative Smiles at Winghaven

  • General Practice Dentistry
  • O'Fallon, MO
National Provider Identifier
1912109646
Registry record updated Apr 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MISSOURI DENTAL PROFESSIONALS, RICHARD STRAUS, DMD, PC
Doing business as
Creative Smiles at Winghaven
Practice address
3011 Winghaven Blvd
O Fallon, MO 63368-3600
Phone
(636) 561-6035
Fax
(636) 561-6066
NPI assigned
Jun 4, 2007
Last updated
Apr 24, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
MISSOURI DENTAL PROFESSIONALS, RICHARD STRAUS, DMD, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 24, 2018

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

Authorized official

Name
Kendra Walker
Title
Credentialing Team Lead
Phone
(217) 540-8513

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

3011 Winghaven Blvd
O Fallon, MO 63368-3600

Mailing address

3011 Winghaven Blvd
O Fallon, MO 63368-3600
Phone (636) 561-6035

Other names 1

  • Creative Smiles at Winghaven Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Missouri Dental Professionals Richard Straus DMD PC60 organizations share this tax ID, including this one
Part of
Missouri Dental Professionals Richard Straus DMD PC

Organizations with this tax ID in the same state 20

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 20

Locations

3011 Winghaven Blvd
O Fallon, MO 63368
Phone (636) 561-6035

Practitioners & affiliated clinicians

Practitioners 2

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": "1180915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524528000000",
    "number": "1912109646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3011 WINGHAVEN BLVD",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633683600",
            "telephone_number": "636-561-6035",
            "fax_number": "636-561-6066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3011 WINGHAVEN BLVD",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633683600",
            "telephone_number": "636-561-6035",
            "fax_number": "636-561-6066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOURI DENTAL PROFESSIONALS, RICHARD STRAUS, DMD, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MISSOURI DENTAL PROFESSIONALS, RICHARD STRAUS, DMD, PC",
        "enumeration_date": "2007-06-04",
        "last_updated": "2018-04-24",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "KENDRA",
        "authorized_official_title_or_position": "CREDENTIALING TEAM LEAD",
        "authorized_official_telephone_number": "217-540-8513"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Creative Smiles at Winghaven",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Creative Smiles at Winghaven",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Apr 24, 2018; 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.