Provider Demographics
NPI:1891107132
Name:CREVE COEUR ORAL SURGERY
Entity Type:Organization
Organization Name:CREVE COEUR ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-361-0760
Mailing Address - Street 1:22 N EUCLID AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1407
Mailing Address - Country:US
Mailing Address - Phone:314-361-0760
Mailing Address - Fax:314-367-7726
Practice Address - Street 1:605 OLD BALLAS RD
Practice Address - Street 2:SUITE 130
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7000
Practice Address - Country:US
Practice Address - Phone:314-361-0760
Practice Address - Fax:314-367-7726
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAY F HAUSER DDS PC DBA PREMIER DENTAL PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty