Provider Demographics
NPI:1720290372
Name:DESHMUKH DDS, PC
Entity Type:Organization
Organization Name:DESHMUKH DDS, PC
Other - Org Name:PERIODONTAL SPECIALISTS , PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIDESH
Authorized Official - Middle Name:DAMODAR
Authorized Official - Last Name:DESHMUKH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-725-4221
Mailing Address - Street 1:1034 S BRENTWOOD BLVD
Mailing Address - Street 2:SUITE #740
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1223
Mailing Address - Country:US
Mailing Address - Phone:314-725-4221
Mailing Address - Fax:314-725-4319
Practice Address - Street 1:1034 S BRENTWOOD BLVD
Practice Address - Street 2:SUITE #740
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1223
Practice Address - Country:US
Practice Address - Phone:314-725-4221
Practice Address - Fax:314-725-4319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0154951223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty