Provider Demographics
NPI:1285203265
Name:SOUTHAMPTON DENTAL LLC
Entity Type:Organization
Organization Name:SOUTHAMPTON DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WEYHAUPT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-647-2828
Mailing Address - Street 1:1501 HAMPTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139
Mailing Address - Country:US
Mailing Address - Phone:314-647-2828
Mailing Address - Fax:314-647-2793
Practice Address - Street 1:1501 HAMPTON AVENUE
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139
Practice Address - Country:US
Practice Address - Phone:314-647-2828
Practice Address - Fax:314-647-2793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty