Provider Demographics
NPI:1366825598
Name:KRILL, MARA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARA
Middle Name:
Last Name:KRILL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PIPER HILL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1616
Mailing Address - Country:US
Mailing Address - Phone:636-477-1000
Mailing Address - Fax:
Practice Address - Street 1:5800 HIGHLANDS PLAZA DR
Practice Address - Street 2:APT. 128
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1356
Practice Address - Country:US
Practice Address - Phone:513-260-8708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030162122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist