Organization
GATEWAY ORAL AND MAXILLOFACIAL SURGEONS OF ST LOUIS, P.C.
Active
Other names
Travis & Nolen Oral & Maxillofacial Surgery, P.C.
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DAUN M. BRANDT (BUSINESS MANAGER)
(314) 726-2755
Entity
Organization
Contact information
Practice address
165 N. MERAMEC AVE, SUITE 300, CLAYTON, MO 63105-3772
(314) 726-2755
(314) 726-9538
Mailing address
165 N. MERAMEC AVE, SUITE 300, CLAYTON, MO 63105-3772
(314) 726-2755
(314) 726-9538
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12435
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
990001492
MEDICARE GROUP ID
MO
Enumeration date
02/13/2008
Last updated
04/11/2023
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