Organization · NPI-2

Advanced Dentistry Of O'Fallon LLC

Dentist, General Practice · O Fallon, MO

NPI number1750176103
StatusActive
Last updated in NPPESApr 14, 2025

Details

NPI
1750176103
Entity type
Organization (NPI-2)
Legal business name
Advanced Dentistry Of O'Fallon LLC
Organization subpart
No
Enumeration date
Apr 14, 2025
Certification date
Apr 14, 2025
Last updated
Apr 14, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice––Yes

Other names

  • Advanced Dentistry Of O'Fallon (Doing Business As)

Practice location

2990 Highway K
O Fallon, MO 63368-7861

Phone 636-978-7816

Mailing address

2990 Highway K
O Fallon, MO 63368-7861

Phone 636-978-7816

Authorized official

Stacey Barnes
Practice Manager
6369787816

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