Provider Demographics
NPI:1366856684
Name:ROHRA, ASHOK K JR (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:ASHOK
Middle Name:K
Last Name:ROHRA
Suffix:JR
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11255 OLIVE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7652
Mailing Address - Country:US
Mailing Address - Phone:314-624-9373
Mailing Address - Fax:
Practice Address - Street 1:11255 OLIVE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-624-9373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-14
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180003191223X0400X
OH30.0243801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO830063821Medicaid