Provider Demographics
NPI:1811985088
Name:REDIGER, DOUGLAS HARRY (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:HARRY
Last Name:REDIGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3876 VOGEL RD
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-3776
Mailing Address - Country:US
Mailing Address - Phone:636-282-0550
Mailing Address - Fax:636-282-1011
Practice Address - Street 1:3876 VOGEL RD
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-3776
Practice Address - Country:US
Practice Address - Phone:636-282-0550
Practice Address - Fax:636-282-1011
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01155011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics