Provider Demographics
NPI:1194455691
Name:SHOUMAN AND TEGERDINE DENTISTRY LLC
Entity Type:Organization
Organization Name:SHOUMAN AND TEGERDINE DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMSEY
Authorized Official - Middle Name:O
Authorized Official - Last Name:SHOUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-449-0096
Mailing Address - Street 1:2216 FORUM BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5409
Mailing Address - Country:US
Mailing Address - Phone:573-449-0096
Mailing Address - Fax:573-449-0099
Practice Address - Street 1:2216 FORUM BLVD STE 104
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5409
Practice Address - Country:US
Practice Address - Phone:573-449-0096
Practice Address - Fax:573-449-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty