Provider Demographics
NPI:1225240856
Name:DESHMUKH, VIDESH DAMODAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIDESH
Middle Name:DAMODAR
Last Name:DESHMUKH
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 1:15219 NOONING TREE CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-4401
Mailing Address - Country:US
Mailing Address - Phone:636-532-2418
Mailing Address - Fax:636-530-7381
Practice Address - Street 1:300 CHESTERFIELD CTR
Practice Address - Street 2:SIUTE # 160
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4867
Practice Address - Country:US
Practice Address - Phone:636-530-7335
Practice Address - Fax:636-530-7381
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0154951223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics