Provider Demographics
NPI:1558559948
Name:EDWARD F. TATE D.D.S., P.C.
Entity Type:Organization
Organization Name:EDWARD F. TATE D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-830-9400
Mailing Address - Street 1:333 S KIRKWOOD RD
Mailing Address - Street 2:STE 105
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6161
Mailing Address - Country:US
Mailing Address - Phone:314-909-9200
Mailing Address - Fax:314-909-9212
Practice Address - Street 1:333 S KIRKWOOD RD
Practice Address - Street 2:STE 105
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6161
Practice Address - Country:US
Practice Address - Phone:314-909-9200
Practice Address - Fax:314-909-9212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO011124261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental