Provider Demographics
NPI:1134326077
Name:GREGORY M STUDT DDS PC
Entity Type:Organization
Organization Name:GREGORY M STUDT DDS PC
Other - Org Name:ORAL MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:STUDT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-567-5556
Mailing Address - Street 1:777 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 225W
Mailing Address - City:ST LOUIS
Mailing Address - State:MD
Mailing Address - Zip Code:63141-8708
Mailing Address - Country:US
Mailing Address - Phone:314-567-5556
Mailing Address - Fax:314-995-6077
Practice Address - Street 1:777 S NEW BALLAS RD
Practice Address - Street 2:SUITE 225W
Practice Address - City:ST LOUIS
Practice Address - State:MD
Practice Address - Zip Code:63141-8708
Practice Address - Country:US
Practice Address - Phone:314-567-5556
Practice Address - Fax:314-995-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO16076122300000X
MO10733122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Single Specialty