Provider Demographics
NPI:1639433626
Name:DAVID GUILBEAULT DMD WOODS MILL LLC
Entity Type:Organization
Organization Name:DAVID GUILBEAULT DMD WOODS MILL LLC
Other - Org Name:WOODS MILL DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILBEAULT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-248-2038
Mailing Address - Street 1:1922 EDWARDSVILLE CLUB PLAZA CT
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-3717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14377 WOODLAKE DR
Practice Address - Street 2:STE 115
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5735
Practice Address - Country:US
Practice Address - Phone:314-469-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001740301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty