Provider Demographics
NPI:1356421101
Name:TAEGER, ERNST MARTIN
Entity type:Individual
Prefix:DR
First Name:ERNST
Middle Name:MARTIN
Last Name:TAEGER
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ERNST
Other - Middle Name:MARTIN
Other - Last Name:TAEGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:4137 N US HWY 67
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034
Mailing Address - Country:US
Mailing Address - Phone:314-653-1333
Mailing Address - Fax:314-653-1197
Practice Address - Street 1:4137 N US HWY 67
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034
Practice Address - Country:US
Practice Address - Phone:314-653-1333
Practice Address - Fax:314-653-1197
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO128261223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics