Provider Demographics
NPI:1659021673
Name:MISSOURI LIFETIME DENTAL PROFESSIONALS, RICHARD STRAUS, D.M.D., P.C.
Entity Type:Organization
Organization Name:MISSOURI LIFETIME DENTAL PROFESSIONALS, RICHARD STRAUS, D.M.D., P.C.
Other - Org Name:PREMIER DENTAL PARTNERS WEST COUNTY - OLD BALLAS ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-8905
Mailing Address - Street 1:605 OLD BALLAS RD STE 130
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7070
Mailing Address - Country:US
Mailing Address - Phone:314-256-2135
Mailing Address - Fax:
Practice Address - Street 1:605 OLD BALLAS RD STE 130
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7070
Practice Address - Country:US
Practice Address - Phone:314-256-2135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAY F. HAUSER, DDS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-24
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty