Provider Demographics
NPI:1144238866
Name:MENNEMEYER, VIRGINIA ANN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:ANN
Last Name:MENNEMEYER
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 TROY SQ
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-3108
Mailing Address - Country:US
Mailing Address - Phone:636-528-2141
Mailing Address - Fax:
Practice Address - Street 1:91 TROY SQ
Practice Address - Street 2:SUITE 203
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-3108
Practice Address - Country:US
Practice Address - Phone:636-528-2141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE 0160961223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics