Provider Demographics
NPI:1093463184
Name:OP ORTHODONTICS OF MISSOURI
Entity Type:Organization
Organization Name:OP ORTHODONTICS OF MISSOURI
Other - Org Name:MOSHIRI ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROJECT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-283-8867
Mailing Address - Street 1:777 S NEW BALLAS RD STE 116E
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8716
Mailing Address - Country:US
Mailing Address - Phone:314-427-2237
Mailing Address - Fax:
Practice Address - Street 1:777 S NEW BALLAS RD STE 116E
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8716
Practice Address - Country:US
Practice Address - Phone:314-427-2237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHODONTIC PARTNERS OF MISSOURI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-17
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty