Provider Demographics
NPI:1124020458
Name:RATHGEBER, DAN H (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:H
Last Name:RATHGEBER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5637 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-4219
Mailing Address - Country:US
Mailing Address - Phone:314-892-4445
Mailing Address - Fax:
Practice Address - Street 1:5637 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-4219
Practice Address - Country:US
Practice Address - Phone:314-892-4445
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO12539122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO103792Medicare UPIN
MO277229Medicare UPIN