Provider Demographics
NPI:1750611844
Name:JONATHAN A SHANKER DDS MS & BRIAN A SCHLUETER DMD MS PC
Entity type:Organization
Organization Name:JONATHAN A SHANKER DDS MS & BRIAN A SCHLUETER DMD MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:SHANKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-842-4105
Mailing Address - Street 1:12111 TESSON FERRY PROFESSIONAL CTR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-1250
Mailing Address - Country:US
Mailing Address - Phone:314-842-4105
Mailing Address - Fax:314-842-3580
Practice Address - Street 1:12111 TESSON FERRY PROFESSIONAL CTR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-1250
Practice Address - Country:US
Practice Address - Phone:314-842-4105
Practice Address - Fax:314-842-3580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty