# DR. GREGORY J. PERNOUD, D.D.S., P.C.

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

## Provider details

- **NPI number:** 1780773242
- **Authorized official:** DR. GREGORY J. PERNOUD D.D.S. (PRESIDENT)
- **Authorized official phone:** (636) 937-1515

## Contact information

- **Practice address:** 112 SOUTH SECOND STREET, FESTUS, MO 63028
- **Practice address phone:** (636) 937-1515
- **Practice address fax:** (636) 937-0790
- **Mailing address:** 1204 E HWY 72, ROLLA, MO 65401
- **Mailing address phone:** (573) 364-1934
- **Mailing address fax:** (573) 364-8110

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 012735 | MO | Yes |

## Other

- **Enumeration date:** 10/12/2006
- **Last updated:** 07/29/2013