Provider Demographics
NPI:1881731511
Name:AUSMER, KENNETH L (DMD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:L
Last Name:AUSMER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6680 CHIPPEWA ST
Mailing Address - Street 2:SUITE 100-101
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2537
Mailing Address - Country:US
Mailing Address - Phone:314-353-8994
Mailing Address - Fax:314-353-8997
Practice Address - Street 1:10745 SUNSET HILLS PLZ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1207
Practice Address - Country:US
Practice Address - Phone:314-821-7096
Practice Address - Fax:314-821-4399
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0155641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice