Organization
ST LOUIS CHILDRENS GENERAL ANESTHESIA DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY ANTLE (CEO)
(301) 494-3000
Entity
Organization
Contact information
Practice address
12101 WOODCREST EXECUTIVE DR STE 101, SAINT LOUIS, MO 63141-5047
(301) 494-3000
Mailing address
12101 WOODCREST EXECUTIVE DR STE 101, SAINT LOUIS, MO 63141-5047
(301) 494-3000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
Other
Enumeration date
04/10/2026
Last updated
04/29/2026
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