Provider Demographics
NPI:1336250802
Name:STEVEN D. WEST DDS PC
Entity Type:Organization
Organization Name:STEVEN D. WEST DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-849-3234
Mailing Address - Street 1:10004 KENNERLY RD STE 240
Mailing Address - Street 2:240
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2141
Mailing Address - Country:US
Mailing Address - Phone:314-849-3234
Mailing Address - Fax:314-849-3241
Practice Address - Street 1:10004 KENNERLY RD
Practice Address - Street 2:SUITE 240
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2141
Practice Address - Country:US
Practice Address - Phone:314-849-3234
Practice Address - Fax:314-849-3241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0112791223G0001X
MO0143851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty