Provider Demographics
NPI:1265598676
Name:ST CHARLES COUNTY ORTHODONTICS P.C.
Entity type:Organization
Organization Name:ST CHARLES COUNTY ORTHODONTICS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:V
Authorized Official - Last Name:MORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-441-5777
Mailing Address - Street 1:1335 QUEENS CT
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-7356
Mailing Address - Country:US
Mailing Address - Phone:636-441-5777
Mailing Address - Fax:636-441-3820
Practice Address - Street 1:1335 QUEENS CT
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-7356
Practice Address - Country:US
Practice Address - Phone:636-441-5777
Practice Address - Fax:636-441-3820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO133331223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty