Provider Demographics
NPI:1083819189
Name:STEVEN RAY DEDRICKSON, DDS PC
Entity Type:Organization
Organization Name:STEVEN RAY DEDRICKSON, DDS PC
Other - Org Name:SEVENS DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:DEDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-721-2466
Mailing Address - Street 1:7777 BONHOMME AVE STE 1900
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1941
Mailing Address - Country:US
Mailing Address - Phone:314-721-2466
Mailing Address - Fax:314-725-5311
Practice Address - Street 1:7777 BONHOMME AVE STE 1900
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-1941
Practice Address - Country:US
Practice Address - Phone:314-721-2466
Practice Address - Fax:314-725-5311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO14621122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty