Provider Demographics
NPI:1053467746
Name:ST. LOUIS UNIVERSITY
Entity Type:Organization
Organization Name:ST. LOUIS UNIVERSITY
Other - Org Name:CENTER FOR ADVANCED DENTAL EDUCATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CADE EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLF
Authorized Official - Middle Name:G
Authorized Official - Last Name:BEHRENTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, PHD
Authorized Official - Phone:314-977-8600
Mailing Address - Street 1:3320 RUTGER ST
Mailing Address - Street 2:ROOM 2048
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1122
Mailing Address - Country:US
Mailing Address - Phone:314-977-8363
Mailing Address - Fax:314-977-8617
Practice Address - Street 1:3320 RUTGER ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1122
Practice Address - Country:US
Practice Address - Phone:314-977-8363
Practice Address - Fax:314-977-8617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental