Provider Demographics
NPI:1366657405
Name:STEVEN J. HRIBERNIK, D.M.D., P.C.
Entity Type:Organization
Organization Name:STEVEN J. HRIBERNIK, D.M.D., P.C.
Other - Org Name:ST. LOUIS SOUTH ORAL & MAXILLOFACIAL SURGERY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CAROTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-842-4699
Mailing Address - Street 1:1155 E GANNON DR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2611
Mailing Address - Country:US
Mailing Address - Phone:636-931-4699
Mailing Address - Fax:636-931-5110
Practice Address - Street 1:1155 E GANNON DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2611
Practice Address - Country:US
Practice Address - Phone:636-931-4699
Practice Address - Fax:636-931-5110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0152771223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOV18886Medicare UPIN