# PROVIDE DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Provide Dental- Chesterfield
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952292005
- **Authorized official:** PHILIP SON DMD (OWNER/ GENERAL DENTIST)
- **Authorized official phone:** (323) 787-9397

## Contact information

- **Practice address:** 14377 WOODLAKE DR STE 205, CHESTERFIELD, MO 63017-5735
- **Practice address phone:** (314) 576-0088
- **Mailing address:** 2211 OLIVE ST STE 100, SAINT LOUIS, MO 63103-1502
- **Mailing address phone:** (314) 776-7100
- **Mailing address fax:** (314) 776-7469

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/15/2025
- **Last updated:** 07/15/2025