NPIMap

Organization Active NPI

Provide Dental

  • Dental Clinic/Center
  • Chesterfield, MO
National Provider Identifier
1952292005
Registry record updated Jul 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
PROVIDE DENTAL
Practice address
14377 Woodlake Dr Ste 205
Chesterfield, MO 63017-5735
Phone
(314) 576-0088
NPI assigned
Jul 15, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2025

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

Authorized official

Name
Philip Son, DMDNPI 1124696083
Title
Owner/ General Dentist
Phone
(323) 787-9397

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
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

14377 Woodlake Dr Ste 205
Chesterfield, MO 63017-5735

Mailing address

2211 Olive St Ste 100
Saint Louis, MO 63103-1502
Phone (314) 776-7100

Other names 1

  • Provide Dental- Chesterfield Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Provide Dental3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

14377 Woodlake Dr
Ste 205
Chesterfield, MO 63017
Phone (314) 576-0088

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1752537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752537600000",
    "number": "1952292005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2211 OLIVE ST STE 100",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631031502",
            "telephone_number": "314-776-7100",
            "fax_number": "314-776-7469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14377 WOODLAKE DR STE 205",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630175735",
            "telephone_number": "314-576-0088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-15",
        "last_updated": "2025-07-15",
        "certification_date": "2025-07-15",
        "status": "A",
        "authorized_official_last_name": "SON",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_title_or_position": "OWNER/ GENERAL DENTIST",
        "authorized_official_telephone_number": "323-787-9397",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Provide Dental- Chesterfield",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chesterfield, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2025; 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.