Provider Demographics
NPI:1619405768
Name:DEFOREST, AARON DREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:DREW
Last Name:DEFOREST
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 HUNTINGTON DOWNS
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-8700
Mailing Address - Country:US
Mailing Address - Phone:314-974-3509
Mailing Address - Fax:
Practice Address - Street 1:2600 RAYMOND DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-4843
Practice Address - Country:US
Practice Address - Phone:636-946-6538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170170941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice