Provider Demographics
NPI:1134649312
Name:KEGLAR, STEVEN JAMAAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JAMAAL
Last Name:KEGLAR
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 1:142 TUSCANY TRACE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-4239
Mailing Address - Country:US
Mailing Address - Phone:317-413-2425
Mailing Address - Fax:
Practice Address - Street 1:12221 SAINT CHARLES ROCK RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2502
Practice Address - Country:US
Practice Address - Phone:314-764-7434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017017251122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist