Provider Demographics
NPI:1821228628
Name:RETI, ROBERT ALEXANDER PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALEXANDER PETER
Last Name:RETI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10000 WATSON RD
Mailing Address - Street 2:A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1841
Mailing Address - Country:US
Mailing Address - Phone:314-822-3322
Mailing Address - Fax:314-822-0537
Practice Address - Street 1:10000 WATSON RD
Practice Address - Street 2:A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1841
Practice Address - Country:US
Practice Address - Phone:314-822-3322
Practice Address - Fax:314-822-0537
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130066201223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery