Provider Demographics
NPI:1437323888
Name:RONALD R MAINHURST DMD PC
Entity Type:Organization
Organization Name:RONALD R MAINHURST DMD PC
Other - Org Name:MACKENZIE POINTE DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:MAINHURST
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:314-352-3886
Mailing Address - Street 1:7313 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4405
Mailing Address - Country:US
Mailing Address - Phone:314-352-3886
Mailing Address - Fax:314-352-2952
Practice Address - Street 1:7313 WATSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-4405
Practice Address - Country:US
Practice Address - Phone:314-352-3886
Practice Address - Fax:314-352-2952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0145991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty