Provider Demographics
NPI:1114190220
Name:ALLEN SCLAROFF DDS INC
Entity Type:Organization
Organization Name:ALLEN SCLAROFF DDS INC
Other - Org Name:UNIVERSITY ORAL & MAXILLOFACIAL SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCLAROFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-453-9705
Mailing Address - Street 1:1040 N MASON
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-453-9705
Mailing Address - Fax:314-453-9706
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:SUITE 16432
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-361-6006
Practice Address - Fax:314-631-6599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0121701223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6554Medicaid
MO6554Medicaid
MO003010863Medicare PIN