Provider Demographics
NPI:1720412463
Name:SHELLY L. SARICH DDS,MS AND SPENCER ELMORE DDS, MS, PC
Entity Type:Organization
Organization Name:SHELLY L. SARICH DDS,MS AND SPENCER ELMORE DDS, MS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SARICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-379-4500
Mailing Address - Street 1:1053 RONDALE CT
Mailing Address - Street 2:
Mailing Address - City:DARDENNE PRAIRIE
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7368
Mailing Address - Country:US
Mailing Address - Phone:636-379-4500
Mailing Address - Fax:636-272-4551
Practice Address - Street 1:1053 RONDALE CT
Practice Address - Street 2:
Practice Address - City:DARDENNE PRAIRIE
Practice Address - State:MO
Practice Address - Zip Code:63368-7368
Practice Address - Country:US
Practice Address - Phone:636-379-4500
Practice Address - Fax:636-272-4551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty