Provider Demographics
NPI:1700122793
Name:PICKARD & HELMKAMP ORTHODONTICS, LLC
Entity Type:Organization
Organization Name:PICKARD & HELMKAMP ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HELMKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:636-256-2626
Mailing Address - Street 1:121 BAXTER SHOPS
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3800
Mailing Address - Country:US
Mailing Address - Phone:636-256-2626
Mailing Address - Fax:
Practice Address - Street 1:121 BAXTER SHOPS
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63011-3800
Practice Address - Country:US
Practice Address - Phone:636-256-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110398431223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty