1457484222 NPI number — MICHAEL K PARSONS DDS PC

Table of content: (NPI 1457484222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457484222 NPI number — MICHAEL K PARSONS DDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL K PARSONS DDS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MIDWEST ORAL AND MAXILLO FACIAL SURGERY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457484222
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17300 OUTER FORTY ROAD NORTH
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
CHESTERFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-536-5158
Provider Business Mailing Address Fax Number:
636-536-4544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1630 MARKET CENTER BLVD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
O FALLON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-379-1333
Provider Business Practice Location Address Fax Number:
636-379-1334
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PARSONS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
KEITH
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
636-536-5158

Provider Taxonomy Codes

  • Taxonomy code: 204E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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