Provider Demographics
NPI:1558544155
Name:DENNIS SENDEROVICH D.D.S., P.C.
Entity Type:Organization
Organization Name:DENNIS SENDEROVICH D.D.S., P.C.
Other - Org Name:O'FALLON DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SENDEROVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-561-7072
Mailing Address - Street 1:9979 WINGHAVEN BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-3628
Mailing Address - Country:US
Mailing Address - Phone:636-561-7072
Mailing Address - Fax:
Practice Address - Street 1:9979 WINGHAVEN BLVD STE 202
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-3628
Practice Address - Country:US
Practice Address - Phone:636-561-7072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002011686122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty