Provider Demographics
NPI:1952559866
Name:CHESTERFIELD-BANKHEAD DDS ORTHODONTICS PC
Entity Type:Organization
Organization Name:CHESTERFIELD-BANKHEAD DDS ORTHODONTICS PC
Other - Org Name:CHESTERFIELD ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:BANKHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-778-9345
Mailing Address - Street 1:4 WEST DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-1793
Mailing Address - Country:US
Mailing Address - Phone:636-778-9345
Mailing Address - Fax:636-778-9347
Practice Address - Street 1:4 WEST DR
Practice Address - Street 2:SUITE 170
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-1793
Practice Address - Country:US
Practice Address - Phone:636-778-9345
Practice Address - Fax:636-778-9347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0158761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty