Individual
DR. DEREK VADNAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
12105 BRIDGETON SQ, BRIDGETON, MO 63044-2616
(314) 298-7772
(314) 298-9895
Mailing address
12105 BRIDGETON SQ, BRIDGETON, MO 63044-2616
(314) 298-7772
(314) 298-9895
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2008008592
MO
1223G0001X
General Practice Dentistry
60310
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100095990C
—
KS
Enumeration date
07/15/2006
Last updated
01/05/2022
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