# SOUTH COUNTY DENTAL IMAGING CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053647008
- **Authorized official:** DR. JOHN R MONTERUBIO SR. DDS (PRESIDENT)
- **Authorized official phone:** (314) 721-1010

## Contact information

- **Practice address:** 12818 TESSON FERRY RD, SUITE 204, SAINT LOUIS, MO 63128-2945
- **Practice address phone:** (314) 722-2033
- **Practice address fax:** (314) 842-1590
- **Mailing address:** 1034 S BRENTWOOD BLVD, SUITE 1010, SAINT LOUIS, MO 63117-1223
- **Mailing address phone:** (314) 721-1010
- **Mailing address fax:** (314) 721-5276

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0200X | Radiology Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/27/2009
- **Last updated:** 10/27/2009