Provider Demographics
NPI:1053817866
Name:TOWNE CENTRE DENTAL CARE
Entity Type:Organization
Organization Name:TOWNE CENTRE DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL SUPPORT SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-753-8154
Mailing Address - Street 1:132 CHESTERFIELD TOWNE CTR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1230
Mailing Address - Country:US
Mailing Address - Phone:636-733-2363
Mailing Address - Fax:
Practice Address - Street 1:132 CHESTERFIELD TOWNE CTR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1230
Practice Address - Country:US
Practice Address - Phone:636-733-2363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOH OF MISSOURI SAMSON LIU PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty