Provider Demographics
NPI:1861448854
Name:MEENTS, DANA M (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:M
Last Name:MEENTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:DANA
Other - Middle Name:M
Other - Last Name:BRUTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12639 OLD TESSON RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2786
Mailing Address - Country:US
Mailing Address - Phone:314-849-0311
Mailing Address - Fax:314-849-4423
Practice Address - Street 1:1165 N BUTTERFIELD RD
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-1056
Practice Address - Country:US
Practice Address - Phone:417-777-8131
Practice Address - Fax:417-777-8892
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110390207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203834007Medicaid
MO203834007Medicaid
MOH15770Medicare UPIN