Provider Demographics
NPI:1083106413
Name:KRISTIANE NAEGLER DMD, LLC
Entity Type:Organization
Organization Name:KRISTIANE NAEGLER DMD, LLC
Other - Org Name:ACCENT DENTAL CENTER OF WENTZVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-424-0236
Mailing Address - Street 1:853 MEDICAL DR STE 114
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3823
Mailing Address - Country:US
Mailing Address - Phone:636-205-0151
Mailing Address - Fax:
Practice Address - Street 1:853 MEDICAL DR STE 114
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3823
Practice Address - Country:US
Practice Address - Phone:636-205-0151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KRISTIANE NAEGLER DMD, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO158151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty