Provider Demographics
NPI:1912579723
Name:MISSOURI DENTAL PROFESSIONALS, RICHARD STRAUS, DMD, PC
Entity Type:Organization
Organization Name:MISSOURI DENTAL PROFESSIONALS, RICHARD STRAUS, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:1200 NW BUCKNER TARSNEY RD
Mailing Address - Street 2:
Mailing Address - City:GRAIN VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:64029-7876
Mailing Address - Country:US
Mailing Address - Phone:816-867-4115
Mailing Address - Fax:
Practice Address - Street 1:1200 NW BUCKNER TARSNEY RD
Practice Address - Street 2:
Practice Address - City:GRAIN VALLEY
Practice Address - State:MO
Practice Address - Zip Code:64029-7876
Practice Address - Country:US
Practice Address - Phone:816-867-4115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSOURI DENTAL PROFESSIONALS, RICHARD STRAUS, DMD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty