Provider Demographics
NPI:1790822419
Name:EIDELMAN AND TRAUB DDS,INC
Entity Type:Organization
Organization Name:EIDELMAN AND TRAUB DDS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:TRAUB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-353-8994
Mailing Address - Street 1:6680 CHIPPEWA ST
Mailing Address - Street 2:SUITE 100-101
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2537
Mailing Address - Country:US
Mailing Address - Phone:314-353-8994
Mailing Address - Fax:314-353-8997
Practice Address - Street 1:6680 CHIPPEWA ST
Practice Address - Street 2:SUITE 100-101
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2537
Practice Address - Country:US
Practice Address - Phone:314-353-8994
Practice Address - Fax:314-353-8997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty