Organization
PLD OF SOUTH CITY PC
Active
Other names
Pine Lawn Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL TRAVIS DDS (OWNER)
(314) 635-0822
Entity
Organization
Contact information
Practice address
3859 GRAVOIS AVE, SAINT LOUIS, MO 63116-4657
(314) 382-2000
(314) 382-2411
Mailing address
3708 JENNINGS STATION RD, SAINT LOUIS, MO 63121-3500
(314) 382-2000
(314) 382-2411
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/14/2025
Last updated
05/07/2026
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