# DCCT

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

## Provider details

- **NPI number:** 1588818975
- **Authorized official:** DR. REZA ROFOUGARAN MD (CEO)
- **Authorized official phone:** (314) 610-8169

## Contact information

- **Practice address:** 1423 S BIG BEND BLVD, SAINT LOUIS, MO 63117-2203
- **Practice address phone:** (314) 610-8169
- **Mailing address:** PO BOX 9169, SAINT LOUIS, MO 63117-0169
- **Mailing address phone:** (314) 610-8169

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 101819 | MO | Yes |

## Other

- **Enumeration date:** 11/11/2008
- **Last updated:** 11/13/2008